This log is also available as text (s09341.txt) and as a (binary) annotation file (s09341.log).
Generated: Monday, 07-Jun-2010 13:20:27 EDT
(All dates below are surrogates.)
t0: [10:41:49 25/06/2008] tf: [15:26:27 14/07/2008] id: a40376 [view]
t0: [10:40:59 25/06/2008] tf: [10:52:59 18/07/2008] id: a40376n [view]
dd: 3669 ds: 1 ld: CATARACT NOS dd: 9953 ds: 2 ld: ALLERGY, UNSPECIFIED
dd: V1589 ds: 2 ld: HX-HEALTH HAZARDS NEC dd: V163 ds: 1 ld: FAMILY HX-BREAST MALIG
dd: 4019 ds: 1 ld: HYPERTENSION NOS
dd: 4019 ds: 1 ld: HYPERTENSION NOS
dd: 4019 ds: 1 ld: HYPERTENSION NOS dd: 496 ds: 2 ld: CHR AIRWAY OBSTRUCT NEC
dd: 4019 ds: 3 ld: HYPERTENSION NOS dd: 486 ds: 1 ld: PNEUMONIA, ORGANISM NOS dd: 496 ds: 2 ld: CHR AIRWAY OBSTRUCT NEC dd: 7863 ds: 5 ld: HEMOPTYSIS dd: 7931 ds: 4 ld: ABN FINDINGS-LUNG FIELD
dd: 7931 ds: 1 ld: ABN FINDINGS-LUNG FIELD
dd: 2720 ds: 1 ld: PURE HYPERCHOLESTEROLEM dd: 4019 ds: 2 ld: HYPERTENSION NOS dd: 4660 ds: 3 ld: ACUTE BRONCHITIS dd: 4928 ds: 5 ld: EMPHYSEMA NEC dd: 7862 ds: 6 ld: COUGH dd: 7931 ds: 4 ld: ABN FINDINGS-LUNG FIELD
dd: 0389 ds: 5 ld: SEPTICEMIA NOS dd: 1124 ds: 9 ld: CANDIDIASIS OF LUNG dd: 2720 ds: 6 ld: PURE HYPERCHOLESTEROLEM dd: 2765 ds: 3 ld: HYPOVOLEMIA dd: 2859 ds: 4 ld: ANEMIA NOS dd: 4019 ds: 5 ld: HYPERTENSION NOS dd: 48283 ds: 8 ld: PNEUMONIA D/T GRAM-NEG dd: 486 ds: 1 ld: PNEUMONIA, ORGANISM NOS dd: 5070 ds: 1 ld: FOOD/VOMIT PNEUMONITIS dd: 5100 ds: 3 ld: EMPYEMA WITH FISTULA dd: 5119 ds: 4 ld: PLEURAL EFFUSION NOS dd: 51881 ds: 2 ld: RESPIRATORY FAILURE dd: 5849 ds: 2 ld: ACUTE RENAL FAILURE NOS dd: 78552 ds: 7 ld: SEPTIC SHOCK dd: 99592 ds: 6 ld: SYST INFLAM RESPN INFECT
tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Atenolol v1: 100 u1: mg tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Famotidine v1: 20 u1: mg tf: [11:00:00 23/05/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Aspirin v1: 325 u1: mg tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Atorvastatin v1: 10 u1: mg
tf: [14:00:00 25/04/2011] pt: Unit Dose rt: IH fr: ONCE fs: 15 dn: 1 m1: Albuterol Neb Soln v1: 1 u1: NEB tf: [17:00:00 26/04/2011] pt: Unit Dose rt: IH fr: Q4H:PRN m1: Albuterol Neb Soln v1: 1 u1: NEB tf: [17:00:00 27/04/2011] pt: Unit Dose rt: IH fr: Q12H fs: 15, 3 dn: 2 m1: Salmeterol Xinafoate Diskus (50 mcg) v1: 1 u1: INH tf: [17:00:00 27/04/2011] pt: Unit Dose rt: IH fr: Q6H fs: 15, 21, 3, 9 dn: 4 m1: Albuterol Inhaler v1: 2 u1: PUFF tf: [17:00:00 27/04/2011] pt: Unit Dose rt: IH fr: Q6H fs: 15, 21, 3, 9 dn: 4 m1: Ipratropium Bromide MDI v1: 2 u1: PUFF tf: [07:00:00 28/04/2011] pt: Unit Dose rt: PO fr: HS:PRN m1: traZODONE HCl v1: 100 u1: mg tf: [11:00:00 29/04/2011] pt: Unit Dose rt: IV fr: Q6H:PRN m1: Promethazine HCl v1: 12.5 u1: mg tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: BID:PRN m1: Senna v1: 1 u1: TAB tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: Q4-6H:PRN m1: Acetaminophen v1: 325-650 u1: mg tf: [18:00:00 24/05/2011] pt: Unit Dose rt: SC fr: Q12H fs: 15, 3 dn: 2 m1: Heparin v1: 5000 u1: UNIT
tf: [16:00:00 26/04/2011] pt: Unit Dose rt: PO fr: HS:PRN m1: Guaifenesin-Codeine Phosphate v1: 5-10 u1: ml tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: Q6H:PRN m1: Guaifenesin-Dextromethorphan v1: 5 u1: ml
tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: TID:PRN m1: Bismuth Subsalicylate v1: 15 u1: ml
tf: [21:00:00 25/04/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 22 dn: 1 m1: Magnesium Sulfate v1: 4 u1: gm m2: NS v2: 250 u2: ml tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Docusate Sodium v1: 100 u1: mg tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Oxybutynin v1: 5 u1: mg
tf: [16:00:00 26/04/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Ferrous Gluconate v1: 300 u1: mg
tf: [13:00:00 27/04/2011] pt: Unit Dose rt: PO fr: Q24H fs: 12 dn: 1 m1: Levofloxacin v1: 250 u1: mg
tf: [21:00:00 27/04/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Acetylcysteine 20% v1: 600 u1: mg
tf: [16:00:00 27/04/2011] pt: Unit Dose rt: IH fr: ONCE fs: 17 dn: 1 m1: Albuterol Neb Soln v1: 1 u1: NEB tf: [16:00:00 27/04/2011] pt: Unit Dose rt: PO fr: ONCE fs: 17 dn: 1 m1: Aspirin v1: 325 u1: mg
tf: [16:00:00 29/04/2011] pt: Unit Dose rt: IH fr: Q2-3H:PRN m1: Ipratropium Bromide Neb v1: 1 u1: NEB tf: [16:00:00 29/04/2011] pt: Unit Dose rt: IH fr: Q2H:PRN m1: Albuterol Neb Soln v1: 1 u1: NEB
tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: Q24H fs: 12 dn: 1 m1: Levofloxacin v1: 500 u1: mg
tf: [16:00:00 29/04/2011] pt: Unit Dose rt: IH fr: Q6H fs: 18, 0, 6, 12 dn: 4 m1: Albuterol Neb Soln v1: 1 u1: NEB tf: [16:00:00 29/04/2011] pt: Unit Dose rt: IH fr: Q6H fs: 18, 0, 6, 12 dn: 4 m1: Ipratropium Bromide Neb v1: 1 u1: NEB
tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metronidazole v1: 500 u1: mg
tf: [11:00:00 28/04/2011] pt: Unit Dose rt: PO fr: Q4-6H:PRN m1: Lorazepam v1: 0.5-1 u1: mg
tf: [15:00:00 28/04/2011] pt: Unit Dose rt: PO fr: HS:PRN m1: Haloperidol v1: 0.5 u1: mg tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: ONCE fs: 15 dn: 1 m1: Magnesium Oxide v1: 400 u1: mg
tf: [07:00:00 29/04/2011] pt: Unit Dose rt: PO fr: TID:PRN m1: Haloperidol v1: 0.5 u1: mg
tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: ONCE fs: 5 dn: 1 m1: traZODONE HCl v1: 25 u1: mg
tf: [11:00:00 29/04/2011] pt: Unit Dose rt: PO fr: TID:PRN m1: Haloperidol v1: 0.5-1 u1: mg
tf: [14:07:00 24/05/2011] dt: 36195 cu: MICU di: No Disch Status
id: D5W el: 1 cu: MICU cg: -1 io: D5W 100.0ml IV Infusions vo: 100 du: ml rt: Intravenous Push id: Po Intake el: 1 cu: MICU cg: -1 io: Po Intake PO/Gastric du: ml rt: Oral
id: Propofol el: 100 cu: MICU cg: RN io: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions am: 500 du: mcgkgmin rt: IV Drip
id: N/A el: 1 cu: MICU cg: RN io: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions vo: 50 du: vl rt: Intravenous Push 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: [11:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 29/04/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [11:00:00 29/04/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [11:00:00 29/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [11:00:00 29/04/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [11:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 29/04/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [11:00:00 29/04/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 29/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [11:00:00 29/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [11:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [11:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 29/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [11:00:00 29/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [11:00:00 29/04/2011] id: NBP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 40 u2: mmHg st: NotStopd t0: [11:00:00 29/04/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 60.3333 u1: mmHg st: NotStopd t0: [11:00:00 29/04/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 29/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 29/04/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [11:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 29/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [11:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [11:00:00 29/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [11:00:00 29/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5 u1: Deg. C st: NotStopd t0: [11:00:00 29/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.7 u1: Deg. F st: NotStopd t0: [11:00:00 29/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [11:00:00 29/04/2011] id: Daily Weight el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [11:00:00 29/04/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [11:23:00 29/04/2011] id: BSA el: 1033 cu: MICU cg: -1 v1: 0.577351 u1: m2 t0: [11:23:00 29/04/2011] id: Admit Wt el: 1032 cu: MICU cg: -1 v1: 57.96 u1: kg t0: [11:23:00 29/04/2011] id: Allergy 1 el: 1020 cu: MICU cg: -1 t0: [11:23:00 29/04/2011] id: Diagnosis/op el: 1023 cu: MICU cg: -1 v1: PNEUMONIA, ACUTE RENAL FAILURE t0: [11:23:00 29/04/2011] id: Service el: 1026 cu: MICU cg: -1 v1: MED t0: [11:23:00 29/04/2011] id: Admit Ht el: 1034 cu: MICU cg: -1 v1: 2 u1: inches t0: [11:23:00 29/04/2011] id: Readmission el: 1014 cu: MICU cg: -1 t0: [11:23:00 29/04/2011] id: Marital Status el: 1006 cu: MICU cg: -1 v1: M t0: [11:23:00 29/04/2011] id: Religion el: 1000 cu: MICU cg: -1 v1: RCA t0: [11:23:00 29/04/2011] id: Allergy 2 el: 1021 cu: MICU cg: -1 t0: [11:23:00 29/04/2011] id: Ext el: 1010 cu: MICU cg: -1 t0: [11:23:00 29/04/2011] id: PIN el: 1012 cu: MICU cg: -1 t0: [11:23:00 29/04/2011] id: Allergy 3 el: 1022 cu: MICU cg: -1
t0: [11:00:00 29/04/2011] tf: [14:30:00 29/04/2011] dt: 210 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 500 vu: ml t0: [11:15:00 29/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml nb: 1
t0: [11:00:00 29/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [11:00:00 29/04/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 1 u1: torr st: NotStopd t0: [11:00:00 29/04/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [11:00:00 29/04/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [11:00:00 29/04/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT u1: Deg. C st: NotStopd t0: [11:00:00 29/04/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [11:00:00 29/04/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 29/04/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [11:00:00 29/04/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [11:00:00 29/04/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [11:00:00 29/04/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [11:00:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 79 u1: % st: NotStopd t0: [11:00:00 29/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [11:00:00 29/04/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [11:00:00 29/04/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [11:00:00 29/04/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [11:00:00 29/04/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [11:00:00 29/04/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [11:00:00 29/04/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [11:15:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:15:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [11:15:00 29/04/2011] id: NBP el: 0 cu: MICU cg: RN v1: 102 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [11:15:00 29/04/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 66.6667 u1: mmHg st: NotStopd t0: [11:15:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:15:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [11:15:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [11:15:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 87 u1: % st: NotStopd t0: [11:15:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:30:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:30:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:30:00 29/04/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [11:30:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [11:30:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:30:00 29/04/2011] id: NBP el: 0 cu: MICU cg: RN v1: 93 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [11:30:00 29/04/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 63.6667 u1: mmHg st: NotStopd t0: [11:30:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:30:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [11:30:00 29/04/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd t0: [11:30:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [11:30:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [11:30:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:30:00 29/04/2011] tf: [14:00:00 29/04/2011] dt: 150 id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0.8694 vu: ml
t0: [11:15:00 29/04/2011] tf: [12:00:00 10/05/2011] dt: 15885 id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 10 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [11:30:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [11:00:00 29/04/2011] id: IV #2 Reason DC'D el: 0 cu: MICU cg: RN v1: Infiltrated st: NotStopd t0: [11:00:00 29/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 29/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [11:00:00 29/04/2011] id: IV #2 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [11:00:00 29/04/2011] id: IV #2 Site/Size el: 0 cu: MICU cg: RN v1: LL Ant Forearm v2: 20 gauge st: NotStopd t0: [11:00:00 29/04/2011] id: IV Site Appear #2 el: 0 cu: MICU cg: RN v1: Infiltrated st: NotStopd t0: [11:00:00 29/04/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 29/04/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 29/04/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 29/04/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 29/04/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [11:00:00 29/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [11:30:00 29/04/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [11:30:00 29/04/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:30:00 29/04/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [11:30:00 29/04/2011] id: HOB el: 0 cu: MICU cg: RN v1: Flat in Bed st: NotStopd t0: [11:30:00 29/04/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [11:30:00 29/04/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [11:30:00 29/04/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [11:30:00 29/04/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [11:30:00 29/04/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [11:30:00 29/04/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [11:30:00 29/04/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:30:00 29/04/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [11:30:00 29/04/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:30:00 29/04/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [11:30:00 29/04/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [11:30:00 29/04/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [11:30:00 29/04/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [11:30:00 29/04/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Flushed st: NotStopd t0: [11:30:00 29/04/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [11:30:00 29/04/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [11:30:00 29/04/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [11:30:00 29/04/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [11:30:00 29/04/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [11:30:00 29/04/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [11:30:00 29/04/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [11:30:00 29/04/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [11:30:00 29/04/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [11:30:00 29/04/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [12:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 29/04/2011] id: NBP el: 0 cu: MICU cg: RN v1: 79 u1: mmHg v2: 38 u2: mmHg st: NotStopd t0: [12:00:00 29/04/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 51.6667 u1: mmHg st: NotStopd t0: [12:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [12:00:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd
t0: [12:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 0 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 29/04/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Line Placement st: NotStopd
tf: [13:00:00 29/04/2011] pt: IV Piggyback rt: IV fr: Q24H fs: 12 dn: 1 m1: Levofloxacin v1: 500 u1: mg m2: Dextrose 5% v2: 100 u2: ml tf: [13:00:00 29/04/2011] pt: IV Piggyback rt: IV fr: Q8H fs: 12, 20, 4 dn: 3 m1: Metronidazole v1: 500 u1: mg m2: NS v2: 100 u2: ml tf: [14:00:00 29/04/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: DopAmine v1: 400 u1: mg m2: D5W v2: 250 u2: ml tf: [11:00:00 02/05/2011] pt: Unit Dose rt: IV DRIP fr: TITRATE TO m1: Propofol (Generic) v1: 1000 u1: mg
t0: [12:05:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:05:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:05:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:05:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [12:05:00 29/04/2011] id: NBP el: 0 cu: MICU cg: RN v1: 77 u1: mmHg v2: 41 u2: mmHg st: NotStopd t0: [12:05:00 29/04/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 53 u1: mmHg st: NotStopd t0: [12:05:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [12:05:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:05:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [12:05:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [12:05:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [12:05:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:05:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 0 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:38:00 29/04/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.21 rs: Final st: NotStopd t0: [12:38:00 29/04/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -7 rs: Final st: NotStopd t0: [12:38:00 29/04/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [12:38:00 29/04/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 53 u1: mmHg rs: Final st: NotStopd t0: [12:38:00 29/04/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 266 u1: mmHg rs: Final st: NotStopd t0: [12:38:00 29/04/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.21 rs: Final st: NotStopd
t0: [12:38:00 29/04/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [12:38:00 29/04/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd
t0: [12:30:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:30:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:30:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:30:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [12:30:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:30:00 29/04/2011] id: NBP el: 0 cu: MICU cg: RN v1: 98 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [12:30:00 29/04/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 66.6667 u1: mmHg st: NotStopd t0: [12:30:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 92 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [12:30:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [12:30:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:30:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [12:30:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [12:30:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:30:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:50:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:50:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:50:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:50:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:50:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:50:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [12:50:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:50:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 71 u1: mmHg v2: 36 u2: mmHg st: NotStopd t0: [12:50:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 48 u1: mmHg st: NotStopd t0: [12:50:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:50:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [12:50:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [12:50:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:50:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 29/04/2011] tf: [04:00:00 30/04/2011] dt: 1020 id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 160 vu: ml t0: [12:30:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 160 vu: ml t0: [12:55:00 29/04/2011] tf: [14:07:00 24/05/2011] dt: 36072 id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml t0: [12:55:00 29/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 3.4776 vu: ml t0: [12:55:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml
t0: [12:30:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 0 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [12:50:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 0 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 29/04/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 13.2353 u1: ml/cmH st: NotStopd t0: [12:00:00 29/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 29/04/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 1 u1: torr st: NotStopd t0: [12:00:00 29/04/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [12:00:00 29/04/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [12:00:00 29/04/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:4 st: NotStopd t0: [12:00:00 29/04/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 29/04/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 29/04/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [12:00:00 29/04/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:00:00 29/04/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [12:00:00 29/04/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.2 u1: L/min st: NotStopd t0: [12:00:00 29/04/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 29/04/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 39 u1: cmH2O st: NotStopd t0: [12:00:00 29/04/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [12:00:00 29/04/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [12:00:00 29/04/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [12:00:00 29/04/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 4 u1: BPM st: NotStopd t0: [12:00:00 29/04/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [12:00:00 29/04/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:00:00 29/04/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:00:00 29/04/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 400 u1: ml/B st: NotStopd t0: [12:00:00 29/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 450 u1: ml/B st: NotStopd t0: [12:00:00 29/04/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 415 u1: ml/B st: NotStopd t0: [12:00:00 29/04/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:00:00 29/04/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 29/04/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd t0: [12:48:00 29/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:48:00 29/04/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:48:00 29/04/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [12:48:00 29/04/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [12:48:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:48:00 29/04/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
tf: [13:00:00 29/04/2011] pt: Unit Dose rt: IV fr: ONCE fs: 13 dn: 1 m1: Phentolamine Mesylate v1: 5-10 u1: mg
t0: [13:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [13:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 91 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [13:00:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 46 u1: mmHg st: NotStopd t0: [13:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [13:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [13:00:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [13:00:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [14:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 103 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [14:00:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [14:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [14:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [14:00:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [14:00:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 29/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 500 vu: ml t0: [14:00:00 29/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 1000 vu: ml t0: [14:00:00 29/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [14:00:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml
t0: [13:53:00 29/04/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.23 rs: Final st: NotStopd t0: [13:53:00 29/04/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [13:53:00 29/04/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -8 rs: Final st: NotStopd t0: [13:53:00 29/04/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [13:53:00 29/04/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [13:53:00 29/04/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 306 u1: mmHg rs: Final st: NotStopd t0: [13:53:00 29/04/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.23 rs: Final st: NotStopd t0: [13:53:00 29/04/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd
id: Levophed-k el: 100 cu: MICU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions am: 4 du: mcgkgmin rt: IV Drip
io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ra: 64 ru: ml/hr
tf: [11:00:00 02/05/2011] pt: IV Piggyback rt: IV fr: Q12H fs: 14, 2 dn: 2 m1: Vancomycin HCl v1: 1000 u1: mg m2: Iso-Osmotic Dextrose v2: 200 u2: ml tf: [18:00:00 24/05/2011] pt: IV Piggyback rt: IV fr: Q8H fs: 0, 8, 16 dn: 3 m1: Piperacillin-Tazobactam Na v1: 4.5 u1: gm m2: Iso-Osmotic Dextrose v2: 100 u2: ml
id: D5W el: 1 cu: MICU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [12:30:00 29/04/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 40 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Albumin Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.6 u1: mg/dl rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 113 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 5 u1: mEq/L rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.5 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Albumin (>3.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 40 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.6 u1: mg/dl rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 113 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 5 u1: mEq/L rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.5 rs: Final st: NotStopd t0: [12:30:00 29/04/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd
t0: [14:10:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:10:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:10:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:10:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:10:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:10:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [14:10:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:10:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 86 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [14:10:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [14:10:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:10:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [14:10:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [14:10:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [14:10:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 29/04/2011] tf: [14:07:00 24/05/2011] dt: 36007 id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.294456 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:10:00 29/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.303658 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:10:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 0 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 29/04/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 29/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [13:00:00 29/04/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd t0: [14:00:00 29/04/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [14:00:00 29/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [14:00:00 29/04/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN st: NotStopd t0: [14:00:00 29/04/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [14:00:00 29/04/2011] id: IV #2 Reason DC'D el: 0 cu: MICU cg: RN v1: Infiltrated st: NotStopd t0: [14:00:00 29/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [14:00:00 29/04/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [14:00:00 29/04/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 29/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 29/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 2 To pain st: NotStopd t0: [14:00:00 29/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [14:00:00 29/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 29/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [14:00:00 29/04/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [14:00:00 29/04/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 29/04/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 29/04/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 29/04/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [14:00:00 29/04/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 29/04/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 29/04/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 29/04/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 29/04/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 29/04/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [14:00:00 29/04/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [14:00:00 29/04/2011] id: IV #2 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [14:00:00 29/04/2011] id: IV #2 Site/Size el: 0 cu: MICU cg: RN v1: LL Ant Forearm v2: 20 gauge st: NotStopd t0: [14:00:00 29/04/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 29/04/2011] id: IV Site Appear #2 el: 0 cu: MICU cg: RN st: NotStopd t0: [14:00:00 29/04/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN st: NotStopd t0: [14:00:00 29/04/2011] id: ImpSkin Character #3 el: 0 cu: MICU cg: RN st: NotStopd t0: [14:00:00 29/04/2011] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [14:00:00 29/04/2011] id: ImpSkin Treatment #3 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [14:00:00 29/04/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [14:00:00 29/04/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [14:00:00 29/04/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [14:00:00 29/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [14:00:00 29/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [14:00:00 29/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 29/04/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Cardiac Echo st: NotStopd t0: [14:00:00 29/04/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 29/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [14:00:00 29/04/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 29/04/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 29/04/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [14:00:00 29/04/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 29/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [14:00:00 29/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [14:00:00 29/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [14:00:00 29/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [14:00:00 29/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 29/04/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [14:00:00 29/04/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: No Apparent Prob st: NotStopd t0: [14:00:00 29/04/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [14:00:00 29/04/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [14:00:00 29/04/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [14:00:00 29/04/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [14:00:00 29/04/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [14:30:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:30:00 29/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [14:30:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:30:00 29/04/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12.8571 u1: ml/cmH st: NotStopd t0: [14:30:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:30:00 29/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [14:30:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:30:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:30:00 29/04/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [14:30:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [14:30:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:30:00 29/04/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [14:30:00 29/04/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [14:30:00 29/04/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [14:30:00 29/04/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [14:30:00 29/04/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [14:30:00 29/04/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [14:30:00 29/04/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [14:30:00 29/04/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.4 u1: L/min st: NotStopd t0: [14:30:00 29/04/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [14:30:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [14:30:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [14:30:00 29/04/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [14:30:00 29/04/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [14:30:00 29/04/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [14:30:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:30:00 29/04/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [14:30:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [14:30:00 29/04/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [14:30:00 29/04/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [14:30:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [14:30:00 29/04/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [14:30:00 29/04/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [14:30:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [14:30:00 29/04/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 435 u1: ml/B st: NotStopd t0: [14:30:00 29/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 450 u1: ml/B st: NotStopd t0: [14:30:00 29/04/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [14:30:00 29/04/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [14:30:00 29/04/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd t0: [14:30:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 29/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 500 vu: ml t0: [13:00:00 29/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 0 vu: ml nb: 1 t0: [14:00:00 29/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [14:30:00 29/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 0 vu: ml nb: 1 t0: [14:30:00 29/04/2011] tf: [14:07:00 24/05/2011] dt: 35977 id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 1.7388 vu: ml t0: [14:30:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 20 vu: ml
t0: [13:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 10 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [13:30:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 10 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [14:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 10 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [14:30:00 29/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:30:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 10 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [14:57:00 29/04/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.25 rs: Final st: NotStopd t0: [14:57:00 29/04/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [14:57:00 29/04/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -7 rs: Final st: NotStopd t0: [14:57:00 29/04/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [14:57:00 29/04/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 44 u1: mmHg rs: Final st: NotStopd t0: [14:57:00 29/04/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 134 u1: mmHg rs: Final st: NotStopd t0: [14:57:00 29/04/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.25 rs: Final st: NotStopd t0: [14:57:00 29/04/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd
tf: [14:00:00 30/04/2011] pt: Unit Dose rt: IV fr: ONCE fs: 15 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm tf: [17:00:00 30/04/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Norepinephrine v1: 4 u1: mg m2: D5W v2: 250 u2: ml tf: [06:00:00 01/05/2011] pt: Unit Dose rt: SC fr: ASDIR m1: Insulin v1: 0 u1: UNIT
t0: [13:45:00 29/04/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 14 rs: Final st: NotStopd t0: [13:45:00 29/04/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 14 rs: Final st: NotStopd t0: [13:45:00 29/04/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 38 u1: % rs: Final st: NotStopd t0: [13:45:00 29/04/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 11.8 u1: gm/dl rs: Final st: NotStopd t0: [13:45:00 29/04/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 354 rs: Final st: NotStopd t0: [13:45:00 29/04/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 4.28 u1: /mic l rs: Final st: NotStopd t0: [13:45:00 29/04/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 14 rs: Final st: NotStopd
t0: [15:00:00 29/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 1000 vu: ml
t0: [15:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 29/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [15:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 103 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [15:00:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [15:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [15:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [15:00:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 29/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 10 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:19:00 29/04/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.15 rs: Final st: NotStopd t0: [16:19:00 29/04/2011] id: Mixed Venous O2 Blood Gases el: 0 cu: MICU cg: 1663 v1: 52 rs: Final st: NotStopd t0: [16:19:00 29/04/2011] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: MICU cg: 1663 v1: 85 rs: Final st: NotStopd
t0: [16:35:00 29/04/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12.1951 u1: ml/cmH st: NotStopd t0: [16:35:00 29/04/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [16:35:00 29/04/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3.5 st: NotStopd t0: [16:35:00 29/04/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT u1: Deg. C st: NotStopd t0: [16:35:00 29/04/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [16:35:00 29/04/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.6 u1: L/min st: NotStopd t0: [16:35:00 29/04/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:35:00 29/04/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 46 u1: cmH2O st: NotStopd t0: [16:35:00 29/04/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [16:35:00 29/04/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [16:35:00 29/04/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [16:35:00 29/04/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [16:35:00 29/04/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [16:35:00 29/04/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:35:00 29/04/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 490 u1: ml/B st: NotStopd t0: [16:35:00 29/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [16:35:00 29/04/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [16:35:00 29/04/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [16:00:00 29/04/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 29/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [16:00:00 29/04/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 29/04/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 29/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [16:00:00 29/04/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 29/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 29/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 2 To pain st: NotStopd t0: [16:00:00 29/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [16:00:00 29/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 29/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [16:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 29/04/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 29/04/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [16:00:00 29/04/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [16:00:00 29/04/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 29/04/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 29/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [16:00:00 29/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [16:00:00 29/04/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 29/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [16:00:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [16:00:00 29/04/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 29/04/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [16:00:00 29/04/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Bronchial st: NotStopd t0: [16:00:00 29/04/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [16:00:00 29/04/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 29/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [16:00:00 29/04/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 29/04/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 29/04/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [16:00:00 29/04/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 91 u1: % st: NotStopd t0: [16:00:00 29/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 29/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6111 u1: Deg. C st: NotStopd t0: [16:00:00 29/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.7 u1: Deg. F st: NotStopd t0: [16:00:00 29/04/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Cloudy st: NotStopd t0: [16:00:00 29/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [16:00:00 29/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 29/04/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [16:19:00 29/04/2011] id: C.O. (fick) el: 0 cu: MICU cg: RN v1: 7.64188 u1: L/min st: NotStopd t0: [17:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 29/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [17:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 29/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [17:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [17:00:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [17:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [17:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [17:00:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 29/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [16:00:00 29/04/2011] tf: [04:00:00 20/05/2011] dt: 29520 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 15 vu: ml t0: [16:00:00 29/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5.2164 vu: ml t0: [16:00:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [17:00:00 29/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:00:00 29/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 3.4776 vu: ml t0: [17:00:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 25 vu: ml
t0: [16:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 10 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [17:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:00:00 29/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:00:00 29/04/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:00:00 29/04/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [16:00:00 29/04/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:00:00 29/04/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 29/04/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 29/04/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [13:45:00 29/04/2011] id: Differential-Bands Hematology el: 0 cu: MICU cg: 1663 v1: 70 rs: Final st: NotStopd t0: [13:45:00 29/04/2011] id: Differential-Basos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [13:45:00 29/04/2011] id: Differential-Eos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [13:45:00 29/04/2011] id: Differential-Lymphs Hematology el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [13:45:00 29/04/2011] id: Differential-Monos Hematology el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [13:45:00 29/04/2011] id: Differential-Polys Hematology el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd
tf: [10:00:00 03/05/2011] pt: Unit Dose rt: IH fr: Q4-6H:PRN m1: Albuterol Inhaler v1: 4 u1: PUFF tf: [10:00:00 03/05/2011] pt: Unit Dose rt: IH fr: Q4-6H:PRN m1: Ipratropium Bromide MDI v1: 6 u1: PUFF
t0: [18:00:00 29/04/2011] id: Glucose Chemistry el: 0 cu: MICU cg: RN v1: 146 rs: Manual st: NotStopd t0: [18:00:00 29/04/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: RN v1: 146 rs: Manual st: NotStopd
t0: [17:54:00 29/04/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.3 rs: Final st: NotStopd t0: [17:54:00 29/04/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -8 rs: Final st: NotStopd t0: [17:54:00 29/04/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [17:54:00 29/04/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 34 u1: mmHg rs: Final st: NotStopd t0: [17:54:00 29/04/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 158 u1: mmHg rs: Final st: NotStopd t0: [17:54:00 29/04/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.3 rs: Final st: NotStopd
t0: [17:00:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [18:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 29/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [18:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 29/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [18:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 29/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 29/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 2 To pain st: NotStopd t0: [18:00:00 29/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [18:00:00 29/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 29/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [18:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [18:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 29/04/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [18:00:00 29/04/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [18:00:00 29/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [18:00:00 29/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [18:00:00 29/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [18:00:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [18:00:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [18:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [18:00:00 29/04/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Bronchial st: NotStopd t0: [18:00:00 29/04/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Bronchial st: NotStopd t0: [18:00:00 29/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [18:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:00:00 29/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [18:00:00 29/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [18:00:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 29/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 29/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [18:00:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml
t0: [16:00:00 29/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.35 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 29/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.28 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 29/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [19:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 29/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [19:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 29/04/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [19:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 29/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 29/04/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [19:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [19:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 29/04/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [19:00:00 29/04/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [19:00:00 29/04/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [19:00:00 29/04/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [19:00:00 29/04/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [19:00:00 29/04/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [19:00:00 29/04/2011] id: IV #2 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [19:00:00 29/04/2011] id: IV #2 Site/Size el: 0 cu: MICU cg: RN v1: LL Ant Forearm v2: 20 gauge st: NotStopd t0: [19:00:00 29/04/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [19:00:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 94 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [19:00:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [19:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [19:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [19:00:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 29/04/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [19:00:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 29/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [19:00:00 29/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [19:00:00 29/04/2011] tf: [14:07:00 24/05/2011] dt: 35707 id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 32.6 vu: ml t0: [19:00:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 25 vu: ml
t0: [19:00:00 29/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.15 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [19:16:00 29/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [19:16:00 29/04/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [19:16:00 29/04/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [19:16:00 29/04/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [19:16:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [19:16:00 29/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [19:16:00 29/04/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 29/04/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: 2827 v1: 14.4737 u1: ml/cmH st: NotStopd t0: [20:00:00 29/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: 2827 v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 29/04/2011] id: FiO2 Set el: 0 cu: MICU cg: 2827 v1: 0.6 u1: torr st: NotStopd t0: [20:00:00 29/04/2011] id: High Insp. Pressure el: 0 cu: MICU cg: 2827 v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 29/04/2011] id: High Resp. Rate el: 0 cu: MICU cg: 2827 v1: 10 u1: BPM st: NotStopd t0: [20:00:00 29/04/2011] id: I:E Ratio el: 0 cu: MICU cg: 2827 v1: 1:3.2 st: NotStopd t0: [20:00:00 29/04/2011] id: Airway Size el: 0 cu: MICU cg: 2827 v1: 7.5 mm st: NotStopd t0: [20:00:00 29/04/2011] id: Airway Type el: 0 cu: MICU cg: 2827 v1: Endotracheal st: NotStopd t0: [20:00:00 29/04/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: 2827 u1: Deg. C st: NotStopd t0: [20:00:00 29/04/2011] id: Intubation Date el: 0 cu: MICU cg: 2827 v1: 3 v2: 12 st: NotStopd t0: [20:00:00 29/04/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: 2827 v1: 7 st: NotStopd t0: [20:00:00 29/04/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: 2827 v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 29/04/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: 2827 v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 29/04/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: 2827 v1: 12 u1: cmH2O st: NotStopd t0: [20:00:00 29/04/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: 2827 v1: 13.2 u1: L/min st: NotStopd t0: [20:00:00 29/04/2011] id: PEEP Set el: 0 cu: MICU cg: 2827 v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 29/04/2011] id: Apnea Time Interval el: 0 cu: MICU cg: 2827 v1: 20 st: NotStopd t0: [20:00:00 29/04/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: 2827 v1: 43 u1: cmH2O st: NotStopd t0: [20:00:00 29/04/2011] id: Plateau Pressure el: 0 cu: MICU cg: 2827 v1: 17 u1: cmH2O st: NotStopd t0: [20:00:00 29/04/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: 2827 v1: 0 u1: BPM st: NotStopd t0: [20:00:00 29/04/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: 2827 v1: 24 u1: BPM st: NotStopd t0: [20:00:00 29/04/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: 2827 v1: 24 u1: BPM st: NotStopd t0: [20:00:00 29/04/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: 2827 v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: 2827 v1: 95 u1: % st: NotStopd t0: [20:00:00 29/04/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: 2827 v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 29/04/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: 2827 v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 29/04/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: 2827 v1: 555 u1: ml/B st: NotStopd t0: [20:00:00 29/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: 2827 v1: 550 u1: ml/B st: NotStopd t0: [20:00:00 29/04/2011] id: Ventilator Mode el: 0 cu: MICU cg: 2827 v1: Assist Control st: NotStopd t0: [20:00:00 29/04/2011] id: Ventilator Type el: 0 cu: MICU cg: 2827 v1: Drager st: NotStopd t0: [20:00:00 29/04/2011] id: Waveform-Vent el: 0 cu: MICU cg: 2827 v1: RAMP st: NotStopd
t0: [20:07:00 29/04/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.29 rs: Final st: NotStopd t0: [20:07:00 29/04/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -8 rs: Final st: NotStopd t0: [20:07:00 29/04/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [20:07:00 29/04/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 34 u1: mmHg rs: Final st: NotStopd t0: [20:07:00 29/04/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 115 u1: mmHg rs: Final st: NotStopd t0: [20:07:00 29/04/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.29 rs: Final st: NotStopd
t0: [20:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 29/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [20:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 29/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [20:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 87 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [20:00:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [20:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [20:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [20:00:00 29/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 29/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [20:00:00 29/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [20:00:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 29/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [21:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 29/04/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [21:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 29/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [21:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [21:00:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [21:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [21:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [21:00:00 29/04/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [21:00:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 79 u1: % st: NotStopd t0: [21:00:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 29/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 29/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [20:00:00 29/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 43.5 vu: ml t0: [20:00:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 20 vu: ml t0: [21:00:00 29/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml t0: [21:00:00 29/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 29/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [21:00:00 29/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 43.5 vu: ml t0: [21:00:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 20 vu: ml
t0: [20:00:00 29/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [21:00:00 29/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [19:00:00 29/04/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [19:00:00 29/04/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [19:00:00 29/04/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [19:00:00 29/04/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [19:00:00 29/04/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 29/04/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 29/04/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 29/04/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 29/04/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 29/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [20:00:00 29/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 29/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [20:00:00 29/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 29/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 29/04/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Hematoma st: NotStopd t0: [20:00:00 29/04/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN st: NotStopd t0: [20:00:00 29/04/2011] id: ImpSkin Character #3 el: 0 cu: MICU cg: RN st: NotStopd t0: [20:00:00 29/04/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 29/04/2011] id: ImpSkin Treatment #3 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 29/04/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Purple st: NotStopd t0: [20:00:00 29/04/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 29/04/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [20:00:00 29/04/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [20:00:00 29/04/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/04/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 29/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 29/04/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 29/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 29/04/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 29/04/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/04/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/04/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 29/04/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 29/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 29/04/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 29/04/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 29/04/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 29/04/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 29/04/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 29/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [20:00:00 29/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 29/04/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
t0: [21:00:00 29/04/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 41 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 116 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 125 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 144 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 41 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 116 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 125 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 144 rs: Final st: NotStopd
t0: [22:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 29/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [22:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 29/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [22:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 29/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 29/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [22:00:00 29/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [22:00:00 29/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [22:00:00 29/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [22:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [22:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 29/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [22:00:00 29/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [22:00:00 29/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [22:00:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 98 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [22:00:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [22:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [22:00:00 29/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [22:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [22:00:00 29/04/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [22:00:00 29/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [22:00:00 29/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [22:00:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 29/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 29/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [22:00:00 29/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 43.47 vu: ml
t0: [22:00:00 29/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [22:00:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml
t0: [23:00:00 29/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 29/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [23:00:00 29/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 29/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 29/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 29/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 29/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 29/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [23:00:00 29/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 29/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 102 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [23:00:00 29/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [23:00:00 29/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 29/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [23:00:00 29/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [23:00:00 29/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 29/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 29/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 29/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [23:00:00 29/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 43.47 vu: ml t0: [23:00:00 29/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 25 vu: ml
t0: [23:00:00 29/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 29/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 29/04/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 25 cv: 25 ap: none t0: [23:00:00 29/04/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 35.4252 cv: 35.4252 ap: none t0: [23:00:00 29/04/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 60.4252 cv: 5248.05 ap: none t0: [23:00:00 29/04/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 60.4252 cv: 5248.05 ap: none t0: [23:00:00 29/04/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 25 cv: 680 ap: none t0: [23:00:00 29/04/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 35.4252 cv: 4568.05 ap: none t0: [23:00:00 29/04/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 25 cv: 680 ap: none t0: [23:00:00 29/04/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 35.4252 cv: 4568.05 ap: none
t0: [21:00:00 29/04/2011] id: Albumin Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [21:00:00 29/04/2011] id: Albumin (>3.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd
t0: [00:00:00 30/04/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 14.4737 u1: ml/cmH st: NotStopd t0: [00:00:00 30/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 30/04/2011] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.6 u1: torr st: NotStopd t0: [00:00:00 30/04/2011] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 30/04/2011] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 15 u1: BPM st: NotStopd t0: [00:00:00 30/04/2011] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:2.8 st: NotStopd t0: [00:00:00 30/04/2011] id: Airway Size el: 0 cu: MICU cg: CRT v1: 7.5 mm st: NotStopd t0: [00:00:00 30/04/2011] id: Airway Type el: 0 cu: MICU cg: CRT v1: Endotracheal st: NotStopd t0: [00:00:00 30/04/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT u1: Deg. C st: NotStopd t0: [00:00:00 30/04/2011] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 3 v2: 12 st: NotStopd t0: [00:00:00 30/04/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 7 st: NotStopd t0: [00:00:00 30/04/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 30/04/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 30/04/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 15 u1: cmH2O st: NotStopd t0: [00:00:00 30/04/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 15 u1: L/min st: NotStopd t0: [00:00:00 30/04/2011] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 30/04/2011] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [00:00:00 30/04/2011] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [00:00:00 30/04/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 43 u1: cmH2O st: NotStopd t0: [00:00:00 30/04/2011] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 18 u1: cmH2O st: NotStopd t0: [00:00:00 30/04/2011] id: Plateau-Off el: 0 cu: MICU cg: CRT v1: Yes st: NotStopd t0: [00:00:00 30/04/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 6 u1: BPM st: NotStopd t0: [00:00:00 30/04/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 30/04/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [00:00:00 30/04/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: CRT v1: 99 u1: % st: NotStopd t0: [00:00:00 30/04/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 510 u1: ml/B st: NotStopd t0: [00:00:00 30/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 550 u1: ml/B st: NotStopd t0: [00:00:00 30/04/2011] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [00:00:00 30/04/2011] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [00:00:00 30/04/2011] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [00:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [00:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [00:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [00:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [00:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [00:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [00:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [00:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 43.47 vu: ml t0: [00:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 25 vu: ml
t0: [00:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.138026 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 30/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [00:00:00 30/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 30/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [00:00:00 30/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd
t0: [21:00:00 29/04/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [21:00:00 29/04/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 29/04/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 29/04/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 29/04/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 30/04/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 30/04/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 30/04/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 30/04/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 30/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [00:00:00 30/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 30/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [00:00:00 30/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 30/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 30/04/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 30/04/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 30/04/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 30/04/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 30/04/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [00:00:00 30/04/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 30/04/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 30/04/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 30/04/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 30/04/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [00:00:00 30/04/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [00:00:00 30/04/2011] id: IV #2 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [00:00:00 30/04/2011] id: IV #2 Site/Size el: 0 cu: MICU cg: RN v1: LL Ant Forearm v2: 20 gauge st: NotStopd t0: [00:00:00 30/04/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 30/04/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 30/04/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 30/04/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 30/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 30/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 30/04/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 30/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 30/04/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 30/04/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 30/04/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 30/04/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 30/04/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 30/04/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 30/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 30/04/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [00:00:00 30/04/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 30/04/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 30/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [00:00:00 30/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 30/04/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
t0: [00:17:00 30/04/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [00:17:00 30/04/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd
t0: [01:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [01:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [01:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [01:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [01:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [01:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [01:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 84 u1: % st: NotStopd t0: [01:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [01:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 30 vu: ml t0: [01:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 25 vu: ml
t0: [01:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.115 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 30/04/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 140 rs: Manual st: NotStopd
t0: [00:00:00 30/04/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [02:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 97 u1: BPM st: NotStopd t0: [02:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 99 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [02:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [02:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [02:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [02:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 84 u1: % st: NotStopd t0: [02:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 30/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [02:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [02:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 24.9953 vu: ml t0: [02:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 25 vu: ml
t0: [02:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.10582 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 30/04/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 30/04/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [00:00:00 30/04/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [00:00:00 30/04/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 30/04/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 30/04/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 30/04/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 30/04/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 30/04/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 30/04/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 30/04/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [00:00:00 30/04/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 30/04/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [00:00:00 30/04/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [02:00:00 30/04/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [02:00:00 30/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [02:00:00 30/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [02:00:00 30/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [02:00:00 30/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [02:00:00 30/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [02:00:00 30/04/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [02:00:00 30/04/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [02:00:00 30/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [02:00:00 30/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [02:00:00 30/04/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [02:00:00 30/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [02:00:00 30/04/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [02:00:00 30/04/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [02:00:00 30/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [02:00:00 30/04/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Plug st: NotStopd t0: [02:00:00 30/04/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [02:00:00 30/04/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [02:00:00 30/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [02:00:00 30/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [02:00:00 30/04/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [03:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [03:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [03:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [03:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 94 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [03:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [03:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [03:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 87 u1: % st: NotStopd t0: [03:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [03:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 23 vu: ml
t0: [03:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.10582 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 30/04/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 39.4509 cv: 2963.21 ap: none t0: [23:00:00 30/04/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 49.4509 cv: 2993.21 ap: none
t0: [03:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml
t0: [23:00:00 30/04/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 35 cv: 35 ap: none t0: [23:00:00 30/04/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 14.4509 cv: 14.4509 ap: none t0: [23:00:00 30/04/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 35 cv: 617 ap: none t0: [23:00:00 30/04/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 14.4509 cv: 2376.21 ap: none t0: [23:00:00 30/04/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 35 cv: 617 ap: none t0: [23:00:00 30/04/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 14.4509 cv: 6944.25 ap: none
t0: [21:00:00 29/04/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [03:00:00 30/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [03:00:00 30/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [03:00:00 30/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [03:00:00 30/04/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [03:00:00 30/04/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 30/04/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 30/04/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [03:00:00 30/04/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [03:00:00 30/04/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [03:00:00 30/04/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:00:00 30/04/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [03:00:00 30/04/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [03:00:00 30/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [03:00:00 30/04/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [03:00:00 30/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd
t0: [03:00:00 30/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [03:00:00 30/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38 u1: Deg. C st: NotStopd t0: [03:00:00 30/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.4 u1: Deg. F st: NotStopd
t0: [03:00:00 30/04/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [04:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 101 u1: BPM st: NotStopd t0: [04:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 88 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [04:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [04:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [04:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [04:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [04:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [04:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [04:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 23 vu: ml t0: [04:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 0 vu: ml
t0: [04:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.115022 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [04:00:00 30/04/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 20.3704 u1: ml/cmH st: NotStopd t0: [04:00:00 30/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 30/04/2011] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.6 u1: torr st: NotStopd t0: [04:00:00 30/04/2011] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [04:00:00 30/04/2011] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 15 u1: BPM st: NotStopd t0: [04:00:00 30/04/2011] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:2.1 st: NotStopd t0: [04:00:00 30/04/2011] id: Airway Size el: 0 cu: MICU cg: CRT v1: 7.5 mm st: NotStopd t0: [04:00:00 30/04/2011] id: Airway Type el: 0 cu: MICU cg: CRT v1: Endotracheal st: NotStopd t0: [04:00:00 30/04/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35.2 u1: Deg. C st: NotStopd t0: [04:00:00 30/04/2011] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 3 v2: 12 st: NotStopd t0: [04:00:00 30/04/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 7 st: NotStopd t0: [04:00:00 30/04/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 30/04/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 30/04/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 14 u1: cmH2O st: NotStopd t0: [04:00:00 30/04/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 15 u1: L/min st: NotStopd t0: [04:00:00 30/04/2011] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 30/04/2011] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [04:00:00 30/04/2011] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [04:00:00 30/04/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 32 u1: cmH2O st: NotStopd t0: [04:00:00 30/04/2011] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 21 u1: cmH2O st: NotStopd t0: [04:00:00 30/04/2011] id: Plateau-Off el: 0 cu: MICU cg: CRT v1: Yes st: NotStopd t0: [04:00:00 30/04/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 3 u1: BPM st: NotStopd t0: [04:00:00 30/04/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 27 u1: BPM st: NotStopd t0: [04:00:00 30/04/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [04:00:00 30/04/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 3 u1: cmH2O st: NotStopd t0: [04:00:00 30/04/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 600 u1: ml/B st: NotStopd t0: [04:00:00 30/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 550 u1: ml/B st: NotStopd t0: [04:00:00 30/04/2011] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [04:00:00 30/04/2011] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [04:00:00 30/04/2011] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [04:00:00 30/04/2011] id: RSBI Not Completed el: 0 cu: MICU cg: CRT v1: Hemodyn Instabil st: NotStopd
t0: [04:51:00 30/04/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.29 rs: Final st: NotStopd t0: [04:51:00 30/04/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -6 rs: Final st: NotStopd t0: [04:51:00 30/04/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [04:51:00 30/04/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 39 u1: mmHg rs: Final st: NotStopd t0: [04:51:00 30/04/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 79 u1: mmHg rs: Final st: NotStopd t0: [04:51:00 30/04/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.29 rs: Final st: NotStopd
t0: [04:53:00 30/04/2011] id: Mixed Venous O2 Blood Gases el: 0 cu: MICU cg: 1663 v1: 45 rs: Final st: NotStopd t0: [04:53:00 30/04/2011] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: MICU cg: 1663 v1: 74 rs: Final st: NotStopd
t0: [05:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [05:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [05:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 95 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [05:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [05:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [05:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [05:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [05:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [05:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 25 vu: ml t0: [05:00:00 30/04/2011] tf: [14:07:00 24/05/2011] dt: 35107 id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 15 vu: ml
t0: [05:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.115022 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:00:00 30/04/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [03:00:00 30/04/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [06:00:00 30/04/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [06:00:00 30/04/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd
t0: [04:00:00 30/04/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 19.8 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 19.8 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 37.8 u1: % rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 12 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 296 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 4.35 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 19.8 rs: Final st: NotStopd t0: [04:53:00 30/04/2011] id: C.O. (fick) el: 0 cu: MICU cg: 1663 v1: 1.96031 u1: L/min st: NotStopd t0: [05:00:00 30/04/2011] id: SVR el: 0 cu: MICU cg: 1663 v1: 2200 u1: ... st: NotStopd
t0: [04:00:00 30/04/2011] id: PT el: 0 cu: MICU cg: 1663 v1: 14.8 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 35.7 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 14.8 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 35.7 rs: Final st: NotStopd
t0: [06:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [06:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 30/04/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 30/04/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [06:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [06:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 30/04/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 30/04/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [06:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [06:00:00 30/04/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [06:00:00 30/04/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [06:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [06:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 30/04/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Plug st: NotStopd t0: [06:00:00 30/04/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [06:00:00 30/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Rectal st: NotStopd t0: [06:00:00 30/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.7778 u1: Deg. C st: NotStopd t0: [06:00:00 30/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 101.8 u1: Deg. F st: NotStopd t0: [06:00:00 30/04/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [06:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [06:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 25 vu: ml t0: [06:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 20 vu: ml
t0: [06:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.115022 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [10:00:00 03/05/2011] pt: Unit Dose rt: NEB fr: Q4-6H:PRN m1: Acetylcysteine 20% v1: 1-10 u1: ml
t0: [04:00:00 30/04/2011] id: Differential-Bands Hematology el: 0 cu: MICU cg: 1663 v1: 34 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Differential-Basos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Differential-Eos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Differential-Lymphs Hematology el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Differential-Monos Hematology el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Differential-Polys Hematology el: 0 cu: MICU cg: 1663 v1: 58 rs: Final st: NotStopd
t0: [04:00:00 30/04/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 43 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Albumin Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 115 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 157 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Total Bili Chemistry el: 0 cu: MICU cg: 1663 v1: 0.4 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: ALT Enzymes el: 0 cu: MICU cg: 1663 v1: 9 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: AST Enzymes el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Albumin (>3.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Alk. Phosphate Enzymes el: 0 cu: MICU cg: 1663 v1: 48 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Amylase Enzymes el: 0 cu: MICU cg: 1663 v1: 66 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 43 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 115 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 157 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: LDH Enzymes el: 0 cu: MICU cg: 1663 v1: 161 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Total Bili (0-1.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.4 rs: Final st: NotStopd
t0: [06:00:00 30/04/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 153 rs: Manual st: NotStopd
t0: [06:30:00 30/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [06:30:00 30/04/2011] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.6 u1: torr st: NotStopd t0: [06:30:00 30/04/2011] id: Airway Size el: 0 cu: MICU cg: CRT v1: 7.5 mm st: NotStopd t0: [06:30:00 30/04/2011] id: Airway Type el: 0 cu: MICU cg: CRT v1: Endotracheal st: NotStopd t0: [06:30:00 30/04/2011] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 3 v2: 12 st: NotStopd t0: [06:30:00 30/04/2011] id: MDI #3 (Puff/Drug) el: 0 cu: MICU cg: CRT st: NotStopd
t0: [08:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [08:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [08:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [08:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [08:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [08:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [08:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 30/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 30/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38 u1: Deg. C st: NotStopd t0: [08:00:00 30/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.4 u1: Deg. F st: NotStopd t0: [08:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.115022 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:00:00 30/04/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 30/04/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 30/04/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 30/04/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 30/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [08:00:00 30/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 30/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [08:00:00 30/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 30/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 30/04/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 30/04/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 30/04/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 30/04/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [08:00:00 30/04/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 30/04/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 30/04/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [08:00:00 30/04/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [08:00:00 30/04/2011] id: IV #2 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [08:00:00 30/04/2011] id: IV #2 Site/Size el: 0 cu: MICU cg: RN v1: LL Ant Forearm v2: 20 gauge st: NotStopd t0: [08:00:00 30/04/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 30/04/2011] id: IV Site Appear #2 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 30/04/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 30/04/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [08:00:00 30/04/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [08:00:00 30/04/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 30/04/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 30/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [08:00:00 30/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 30/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 30/04/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 30/04/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 30/04/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 30/04/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 30/04/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 30/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 30/04/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 30/04/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 30/04/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 30/04/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 30/04/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Children st: NotStopd t0: [08:00:00 30/04/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 30/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [08:00:00 30/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 30/04/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 30/04/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 30/04/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 30/04/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 30/04/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 30/04/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [08:00:00 30/04/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [08:00:00 30/04/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd
t0: [08:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [08:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [08:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 50 vu: ml t0: [08:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 15 vu: ml
t0: [08:15:00 30/04/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 23.913 u1: ml/cmH st: NotStopd t0: [08:15:00 30/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:15:00 30/04/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [08:15:00 30/04/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [08:15:00 30/04/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:15:00 30/04/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [08:15:00 30/04/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [08:15:00 30/04/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:15:00 30/04/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:15:00 30/04/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [08:15:00 30/04/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:15:00 30/04/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [08:15:00 30/04/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:15:00 30/04/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:15:00 30/04/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [08:15:00 30/04/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.4 u1: L/min st: NotStopd t0: [08:15:00 30/04/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:15:00 30/04/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:15:00 30/04/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [08:15:00 30/04/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [08:15:00 30/04/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [08:15:00 30/04/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [08:15:00 30/04/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:15:00 30/04/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:15:00 30/04/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:15:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:15:00 30/04/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [08:15:00 30/04/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [08:15:00 30/04/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 602 u1: ml/B st: NotStopd t0: [08:15:00 30/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [08:15:00 30/04/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:15:00 30/04/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:15:00 30/04/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [09:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [09:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [09:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 91 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [09:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [09:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [09:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [09:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [09:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [09:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 25 vu: ml t0: [09:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 14 vu: ml
t0: [09:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.115022 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:10:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:10:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [09:10:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:10:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:10:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:10:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [09:10:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 70 u1: mmHg v2: 32 u2: mmHg st: NotStopd t0: [09:10:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [09:10:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:10:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [09:10:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [09:10:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [09:10:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:10:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.184 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:10:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:15:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:15:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [09:15:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:15:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:15:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:15:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [09:15:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 78 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [09:15:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [09:15:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:15:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [09:15:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [09:15:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [09:15:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:15:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.23 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:15:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [10:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [10:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [10:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 95 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [10:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [10:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [10:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [10:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [10:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 44.9922 vu: ml t0: [10:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 14 vu: ml
t0: [10:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.23 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [11:00:00 30/04/2011] id: Total PEEP Level el: 0 cu: MICU cg: RRT v1: 8.8 u1: cmH2O st: NotStopd
t0: [11:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [11:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [11:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [11:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [11:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [11:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [11:00:00 30/04/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [11:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 30/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml t0: [11:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [11:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 49.9905 vu: ml t0: [11:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 13 vu: ml
t0: [11:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [10:00:00 30/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
tf: [20:00:00 04/05/2011] pt: IV Piggyback rt: IV fr: Q8H fs: 0, 8, 16 dn: 3 m1: Metronidazole v1: 500 u1: mg m2: NS v2: 100 u2: ml
t0: [12:00:00 30/04/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 30/04/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [12:00:00 30/04/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 30/04/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 30/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [12:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 30/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 30/04/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Fam Talked to RN st: NotStopd t0: [12:00:00 30/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [12:00:00 30/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 30/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [12:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 30/04/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 30/04/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [12:00:00 30/04/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [12:00:00 30/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 30/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [12:00:00 30/04/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [12:00:00 30/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [12:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [12:00:00 30/04/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [12:00:00 30/04/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 30/04/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 30/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [12:00:00 30/04/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 30/04/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 30/04/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 30/04/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 30/04/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [12:00:00 30/04/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [12:00:00 30/04/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Children st: NotStopd t0: [12:00:00 30/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 30/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5556 u1: Deg. C st: NotStopd t0: [12:00:00 30/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.6 u1: Deg. F st: NotStopd t0: [12:00:00 30/04/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 30/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [12:00:00 30/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 30/04/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 30/04/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [12:00:00 30/04/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [12:00:00 30/04/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [12:00:00 30/04/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [12:00:00 30/04/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [12:00:00 30/04/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [12:00:00 30/04/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd
t0: [12:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [12:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [12:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 44.9 vu: ml t0: [12:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 14 vu: ml
t0: [11:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.206579 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.184035 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 30/04/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 22.9167 u1: ml/cmH st: NotStopd t0: [12:00:00 30/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 30/04/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [12:00:00 30/04/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [12:00:00 30/04/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:00:00 30/04/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [12:00:00 30/04/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [12:00:00 30/04/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 30/04/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 30/04/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [12:00:00 30/04/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [12:00:00 30/04/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [12:00:00 30/04/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 30/04/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 30/04/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [12:00:00 30/04/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.6 u1: L/min st: NotStopd t0: [12:00:00 30/04/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 30/04/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 30/04/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [12:00:00 30/04/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [12:00:00 30/04/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [12:00:00 30/04/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [12:00:00 30/04/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [12:00:00 30/04/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [12:00:00 30/04/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:00:00 30/04/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 528 u1: ml/B st: NotStopd t0: [12:00:00 30/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [12:00:00 30/04/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:00:00 30/04/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 30/04/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [12:00:00 30/04/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 154 rs: Manual st: NotStopd
t0: [04:00:00 30/04/2011] id: Cholesterol Chemistry el: 0 cu: MICU cg: 1663 v1: 35 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 30/04/2011] id: Cholesterol (<200) Chemistry el: 0 cu: MICU cg: 1663 v1: 35 u1: mg/dl rs: Final st: NotStopd
t0: [13:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [13:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [13:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 89 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [13:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [13:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [13:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [13:00:00 30/04/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [13:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 30/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml t0: [13:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [13:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [13:00:00 30/04/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 40 vu: ml t0: [13:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 12 vu: ml
t0: [13:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.184035 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [13:30:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:30:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [13:30:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:30:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:30:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:30:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [13:30:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:30:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [13:30:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [13:30:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:30:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [13:30:00 30/04/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Bronchoscopy st: NotStopd t0: [13:30:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [13:30:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:30:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:30:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.184035 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:30:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [13:35:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:35:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [13:35:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:35:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:35:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:35:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:35:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:35:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [13:35:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:35:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [13:35:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [13:35:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:35:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [13:35:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [13:35:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:35:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:40:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:40:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [13:40:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:40:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:40:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:40:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:40:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:40:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [13:40:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:40:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 102 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [13:40:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [13:40:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:40:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [13:40:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [13:40:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:40:00 30/04/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [13:40:00 30/04/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [13:40:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:45:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:45:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [13:45:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:45:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:45:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:45:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:45:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:45:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [13:45:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:45:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [13:45:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [13:45:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:45:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [13:45:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [13:45:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:45:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:35:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.184035 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:35:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [13:40:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.184035 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:40:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [13:45:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.184035 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:45:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [14:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [14:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [14:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 79 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [14:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 58 u1: mmHg st: NotStopd t0: [14:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [14:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [14:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [14:00:00 30/04/2011] tf: [11:00:00 01/05/2011] dt: 1260 id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 40 vu: ml t0: [14:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 32 vu: ml
t0: [14:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.184035 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [14:00:00 30/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [16:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [16:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [16:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [16:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [16:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [16:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [16:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [16:00:00 30/04/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 80 vu: ml t0: [16:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml
t0: [16:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.184035 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:05:00 30/04/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd t0: [16:05:00 30/04/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [16:05:00 30/04/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -7 rs: Final st: NotStopd t0: [16:05:00 30/04/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [16:05:00 30/04/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 34 u1: mmHg rs: Final st: NotStopd t0: [16:05:00 30/04/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 361 u1: mmHg rs: Final st: NotStopd t0: [16:05:00 30/04/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd t0: [16:05:00 30/04/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd
t0: [16:15:00 30/04/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 20.3704 u1: ml/cmH st: NotStopd t0: [16:15:00 30/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:15:00 30/04/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [16:15:00 30/04/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [16:15:00 30/04/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [16:15:00 30/04/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [16:15:00 30/04/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [16:15:00 30/04/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:15:00 30/04/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [16:15:00 30/04/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [16:15:00 30/04/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:15:00 30/04/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [16:15:00 30/04/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:15:00 30/04/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:15:00 30/04/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [16:15:00 30/04/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.5 u1: L/min st: NotStopd t0: [16:15:00 30/04/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:15:00 30/04/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:15:00 30/04/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [16:15:00 30/04/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [16:15:00 30/04/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [16:15:00 30/04/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [16:15:00 30/04/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [16:15:00 30/04/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [16:15:00 30/04/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:15:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [16:15:00 30/04/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [16:15:00 30/04/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [16:15:00 30/04/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 602 u1: ml/B st: NotStopd t0: [16:15:00 30/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [16:15:00 30/04/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [16:15:00 30/04/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:15:00 30/04/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [17:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [17:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [17:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [17:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [17:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [17:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [17:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 30/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [17:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [17:00:00 30/04/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 40 vu: ml t0: [17:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 38 vu: ml
t0: [17:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.161 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:00:00 30/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 30/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3889 u1: Deg. C st: NotStopd t0: [16:00:00 30/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.3 u1: Deg. F st: NotStopd
t0: [16:30:00 30/04/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [18:00:00 30/04/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [18:00:00 30/04/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [18:00:00 30/04/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 30/04/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [18:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 30/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [18:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 30/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [18:00:00 30/04/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [18:00:00 30/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [18:00:00 30/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 30/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [18:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [18:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 30/04/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [18:00:00 30/04/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 30/04/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [18:00:00 30/04/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [18:00:00 30/04/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 30/04/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [18:00:00 30/04/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [18:00:00 30/04/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [18:00:00 30/04/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [18:00:00 30/04/2011] id: IV #2 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [18:00:00 30/04/2011] id: IV #2 Site/Size el: 0 cu: MICU cg: RN v1: LL Ant Forearm v2: 20 gauge st: NotStopd t0: [18:00:00 30/04/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [18:00:00 30/04/2011] id: IV Site Appear #2 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [18:00:00 30/04/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [18:00:00 30/04/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [18:00:00 30/04/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [18:00:00 30/04/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [18:00:00 30/04/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [18:00:00 30/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [18:00:00 30/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [18:00:00 30/04/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [18:00:00 30/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [18:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [18:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [18:00:00 30/04/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [18:00:00 30/04/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 30/04/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 30/04/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 30/04/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 30/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [18:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [18:00:00 30/04/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 30/04/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 30/04/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 30/04/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 30/04/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [18:00:00 30/04/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [18:00:00 30/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [18:00:00 30/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [18:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 30/04/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [18:00:00 30/04/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [18:00:00 30/04/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [18:00:00 30/04/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [18:00:00 30/04/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [18:00:00 30/04/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [18:00:00 30/04/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [18:00:00 30/04/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd
t0: [18:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [18:00:00 30/04/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 34.9934 vu: ml t0: [18:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml
t0: [18:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.138 du: mcgkgmin sv: 250 su: ml rt: IV Drip
id: Levophed-k el: 101 cu: MICU 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: MICU cg: RN ra: 14.9971 ru: ml/hr
tf: [10:00:00 04/05/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Norepinephrine v1: 8 u1: mg m2: D5W v2: 250 u2: ml
id: D5W el: 1 cu: MICU cg: RN io: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips vo: 250 du: ml rt: Intravenous Push
t0: [18:30:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:30:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [18:30:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:30:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [18:30:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:30:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [18:30:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [18:30:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:30:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [18:30:00 30/04/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Chest Tube In st: NotStopd t0: [18:30:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [18:30:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:30:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 43.1332 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [18:30:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.138 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:30:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 43.1332 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [19:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [19:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [19:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [19:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [19:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [19:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [19:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [19:15:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:15:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [19:15:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:15:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:15:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:15:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 90 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [19:15:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [19:15:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:15:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [19:30:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:30:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [19:30:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:30:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:30:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:30:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [19:30:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:30:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 73 u1: mmHg v2: 41 u2: mmHg st: NotStopd t0: [19:30:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 53 u1: mmHg st: NotStopd t0: [19:30:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:30:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [19:30:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [19:30:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:30:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.138 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 43.1332 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [19:15:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.138 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:15:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 43.1332 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [19:30:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.15 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:30:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [19:00:00 30/04/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Very Sedated st: NotStopd
t0: [19:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [19:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15 vu: ml t0: [19:00:00 30/04/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 14.9971 vu: ml
t0: [20:00:00 30/04/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 23.913 u1: ml/cmH st: NotStopd t0: [20:00:00 30/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 30/04/2011] id: high exhale MV el: 0 cu: MICU cg: CRT v1: 18 t0: [20:00:00 30/04/2011] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.6 u1: torr st: NotStopd t0: [20:00:00 30/04/2011] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 40 u1: cmH2O st: NotStopd t0: [20:00:00 30/04/2011] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 15 u1: BPM st: NotStopd t0: [20:00:00 30/04/2011] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:2.1 st: NotStopd t0: [20:00:00 30/04/2011] id: Airway Size el: 0 cu: MICU cg: CRT v1: 7.5 mm st: NotStopd t0: [20:00:00 30/04/2011] id: Airway Type el: 0 cu: MICU cg: CRT v1: Endotracheal st: NotStopd t0: [20:00:00 30/04/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 34 u1: Deg. C st: NotStopd t0: [20:00:00 30/04/2011] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 3 v2: 12 st: NotStopd t0: [20:00:00 30/04/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 7 st: NotStopd t0: [20:00:00 30/04/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 30/04/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 30/04/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 11 u1: cmH2O st: NotStopd t0: [20:00:00 30/04/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 13 u1: L/min st: NotStopd t0: [20:00:00 30/04/2011] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 30/04/2011] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [20:00:00 30/04/2011] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [20:00:00 30/04/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 28 u1: cmH2O st: NotStopd t0: [20:00:00 30/04/2011] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 17 u1: cmH2O st: NotStopd t0: [20:00:00 30/04/2011] id: Plateau-Off el: 0 cu: MICU cg: CRT v1: Yes st: NotStopd t0: [20:00:00 30/04/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 0 u1: BPM st: NotStopd t0: [20:00:00 30/04/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [20:00:00 30/04/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [20:00:00 30/04/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: CRT v1: 100 u1: % st: NotStopd t0: [20:00:00 30/04/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 542 u1: ml/B st: NotStopd t0: [20:00:00 30/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 550 u1: ml/B st: NotStopd t0: [20:00:00 30/04/2011] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [20:00:00 30/04/2011] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [20:00:00 30/04/2011] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [19:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml t0: [20:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 12.7164 vu: ml t0: [20:00:00 30/04/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 15.6492 vu: ml t0: [20:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml
t0: [20:00:00 30/04/2011] id: IV #2 Reason DC'D el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 30/04/2011] id: IV Site Appear #2 el: 0 cu: MICU cg: -1 st: D/C'd
io: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ra: 10 ru: ml/hr
id: Vivonex el: 1 cu: MICU cg: RN io: Vivonex Tube Feeding du: str rt: Gastric/Feeding Tube
t0: [20:00:00 30/04/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 30/04/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 30/04/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 30/04/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 30/04/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 30/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [20:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 30/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 30/04/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 30/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [20:00:00 30/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 30/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 30/04/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 30/04/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 30/04/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 30/04/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [20:00:00 30/04/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 30/04/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 30/04/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 30/04/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 30/04/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 30/04/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [20:00:00 30/04/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [20:00:00 30/04/2011] id: IV #2 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [20:00:00 30/04/2011] id: IV #2 Site/Size el: 0 cu: MICU cg: RN v1: LL Ant Forearm v2: 20 gauge st: NotStopd t0: [20:00:00 30/04/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 30/04/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 30/04/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [20:00:00 30/04/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [20:00:00 30/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [20:00:00 30/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 30/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 30/04/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 30/04/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 30/04/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 30/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 30/04/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 30/04/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 30/04/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 30/04/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 30/04/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 30/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 30/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3889 u1: Deg. C st: NotStopd t0: [20:00:00 30/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.3 u1: Deg. F st: NotStopd t0: [20:00:00 30/04/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 30/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [20:00:00 30/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 30/04/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 30/04/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.175 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [20:30:00 30/04/2011] id: ETT Mark/Location el: 0 cu: MICU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [20:30:00 30/04/2011] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [20:30:00 30/04/2011] id: Airway Size el: 0 cu: MICU cg: CRT v1: 7.5 mm st: NotStopd t0: [20:30:00 30/04/2011] id: Airway Type el: 0 cu: MICU cg: CRT v1: Endotracheal st: NotStopd t0: [20:30:00 30/04/2011] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 3 v2: 12 st: NotStopd t0: [20:30:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: CRT v1: 100 u1: % st: NotStopd t0: [20:30:00 30/04/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [20:30:00 30/04/2011] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd
t0: [20:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [20:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [20:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [20:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [20:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [20:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [20:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 30/04/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml nb: 1
t0: [20:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:00:00 30/04/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 30/04/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 30/04/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 30/04/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 30/04/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 30/04/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [20:00:00 30/04/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd
t0: [21:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [21:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [21:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [21:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [21:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [21:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [21:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [21:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 30/04/2011] tf: [12:00:00 07/05/2011] dt: 9540 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [21:00:00 30/04/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 19.0181 vu: ml t0: [21:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml
t0: [21:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.175 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [21:00:00 30/04/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd t0: [21:00:00 30/04/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -6 rs: Final st: NotStopd t0: [21:00:00 30/04/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [21:00:00 30/04/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 32 u1: mmHg rs: Final st: NotStopd t0: [21:00:00 30/04/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 107 u1: mmHg rs: Final st: NotStopd t0: [21:00:00 30/04/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd
t0: [22:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [22:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 30/04/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [22:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [22:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 103 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [22:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [22:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [22:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [22:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [22:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 30/04/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [22:00:00 30/04/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 19.0181 vu: ml t0: [22:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml
t0: [22:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.175 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [10:00:00 03/05/2011] pt: IV Piggyback rt: IV fr: BID fs: 10, 22 dn: 2 m1: Methylprednisolone Na Succ. v1: 60 u1: mg m2: Syringe (IV Room) v2: 1 u2: SYR
t0: [23:00:00 30/04/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 30/04/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [23:00:00 30/04/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 30/04/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 30/04/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 30/04/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 30/04/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 30/04/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [23:00:00 30/04/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 30/04/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [23:00:00 30/04/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [23:00:00 30/04/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [23:00:00 30/04/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [23:00:00 30/04/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 30/04/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [23:00:00 30/04/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [23:00:00 30/04/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [23:00:00 30/04/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 30/04/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 30/04/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 30/04/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [23:00:00 30/04/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 19.0181 vu: ml t0: [23:00:00 30/04/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml
t0: [23:00:00 30/04/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.175 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 30/04/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 30/04/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 10 cv: 30 ap: none
t0: [00:00:00 01/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 33.3333 u1: ml/cmH st: NotStopd t0: [00:00:00 01/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 01/05/2011] id: high exhale MV el: 0 cu: MICU cg: CRT v1: 18 t0: [00:00:00 01/05/2011] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 01/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 40 u1: cmH2O st: NotStopd t0: [00:00:00 01/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 15 u1: BPM st: NotStopd t0: [00:00:00 01/05/2011] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:2.1 st: NotStopd t0: [00:00:00 01/05/2011] id: Airway Size el: 0 cu: MICU cg: CRT v1: 7.5 mm st: NotStopd t0: [00:00:00 01/05/2011] id: Airway Type el: 0 cu: MICU cg: CRT v1: Endotracheal st: NotStopd t0: [00:00:00 01/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35.2 u1: Deg. C st: NotStopd t0: [00:00:00 01/05/2011] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 3 v2: 12 st: NotStopd t0: [00:00:00 01/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 7 st: NotStopd t0: [00:00:00 01/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 01/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 01/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 01/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 11.4 u1: L/min st: NotStopd t0: [00:00:00 01/05/2011] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 01/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [00:00:00 01/05/2011] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [00:00:00 01/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 20 u1: cmH2O st: NotStopd t0: [00:00:00 01/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 16 u1: cmH2O st: NotStopd t0: [00:00:00 01/05/2011] id: Plateau-Off el: 0 cu: MICU cg: CRT v1: Yes st: NotStopd t0: [00:00:00 01/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 0 u1: BPM st: NotStopd t0: [00:00:00 01/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [00:00:00 01/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [00:00:00 01/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: CRT v1: 98 u1: % st: NotStopd t0: [00:00:00 01/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 431 u1: ml/B st: NotStopd t0: [00:00:00 01/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [00:00:00 01/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [00:00:00 01/05/2011] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [00:00:00 01/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [00:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [00:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [00:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [00:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [00:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [00:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 01/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [00:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [00:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 19.0181 vu: ml t0: [00:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 25 vu: ml
t0: [00:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.175 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 01/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 211 rs: Manual st: NotStopd
t0: [01:00:00 01/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [01:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [01:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 19.0181 vu: ml
t0: [20:00:00 30/04/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [20:00:00 30/04/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 30/04/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [22:00:00 30/04/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 30/04/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 30/04/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 30/04/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [22:00:00 30/04/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [22:00:00 30/04/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [22:00:00 30/04/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [22:00:00 30/04/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [22:00:00 30/04/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [22:00:00 30/04/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [22:00:00 30/04/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [22:00:00 30/04/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [22:00:00 30/04/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [22:00:00 30/04/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [22:00:00 30/04/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [22:00:00 30/04/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [22:00:00 30/04/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [22:00:00 30/04/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [22:00:00 30/04/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [22:00:00 30/04/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [22:00:00 30/04/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [22:00:00 30/04/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 30/04/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [22:00:00 30/04/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 30/04/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [22:00:00 30/04/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [22:00:00 30/04/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [22:00:00 30/04/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [22:00:00 30/04/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [22:00:00 30/04/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [22:00:00 30/04/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [22:00:00 30/04/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [22:00:00 30/04/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [22:00:00 30/04/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [22:00:00 30/04/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 30/04/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 30/04/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [22:00:00 30/04/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [22:00:00 30/04/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 30/04/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 30/04/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [22:00:00 30/04/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 30/04/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 30/04/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 30/04/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 30/04/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [22:00:00 30/04/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [22:00:00 30/04/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [22:00:00 30/04/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [22:00:00 30/04/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [22:00:00 30/04/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [22:00:00 30/04/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 01/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 01/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 01/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 01/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 01/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 01/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [00:00:00 01/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 01/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 01/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 01/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 01/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 01/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 01/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 01/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [00:00:00 01/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 01/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 01/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 01/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 01/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 01/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [00:00:00 01/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [00:00:00 01/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 01/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 01/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [00:00:00 01/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [00:00:00 01/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 01/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 01/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 01/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 01/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 01/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 01/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 01/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 01/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 01/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 01/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 01/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 01/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 01/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 01/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 01/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 01/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 01/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 01/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 01/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 01/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [00:00:00 01/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 01/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 01/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [01:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [01:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [01:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [01:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [01:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [01:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.147228 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [01:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 65 vu: ml
t0: [20:00:00 30/04/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 30/04/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [20:00:00 30/04/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [20:00:00 30/04/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 30/04/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [20:00:00 30/04/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [22:00:00 30/04/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [22:00:00 30/04/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [22:00:00 30/04/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serosanguinous st: NotStopd t0: [22:00:00 30/04/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [22:00:00 30/04/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [22:00:00 30/04/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 01/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 01/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [00:00:00 01/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 01/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [00:00:00 01/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [02:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [02:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [02:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [02:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [02:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [02:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [02:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 16 vu: ml t0: [02:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml
t0: [02:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [02:00:00 01/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [02:00:00 01/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [02:00:00 01/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [03:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [03:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [03:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [03:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [03:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [03:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 15.2145 vu: ml t0: [03:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 25 vu: ml
t0: [03:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:10:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:10:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:10:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:10:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:10:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 131 u1: BPM st: NotStopd t0: [03:10:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [03:10:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [03:10:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:10:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:10:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:10:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:10:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:15:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:15:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:15:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:15:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:15:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 131 u1: BPM st: NotStopd t0: [03:15:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [03:15:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [03:15:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:15:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:15:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:15:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:15:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:20:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:20:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:20:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:20:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:20:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 131 u1: BPM st: NotStopd t0: [03:20:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [03:20:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [03:20:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:20:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:20:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:20:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:20:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:25:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:25:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:25:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:25:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:25:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 131 u1: BPM st: NotStopd t0: [03:25:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [03:25:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [03:25:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:25:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:25:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:25:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:25:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:30:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:30:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:30:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:30:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:30:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [03:30:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 99 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [03:30:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [03:30:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:30:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:30:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:30:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:30:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:35:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:35:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:35:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:35:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:35:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [03:35:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [03:35:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [03:35:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:35:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:35:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:35:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [03:35:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:40:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:40:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:40:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:40:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:40:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 133 u1: BPM st: NotStopd t0: [03:40:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 86 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [03:40:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [03:40:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:40:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:40:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:40:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [03:40:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:45:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:45:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:45:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:45:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:45:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 110 u1: BPM st: NotStopd t0: [03:45:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 99 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [03:45:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [03:45:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:45:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:45:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:45:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [03:45:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:50:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:50:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:50:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:50:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:50:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 126 u1: BPM st: NotStopd t0: [03:50:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [03:50:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [03:50:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:50:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:50:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [03:50:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:55:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:55:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:55:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:55:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:55:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 120 u1: BPM st: NotStopd t0: [03:55:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 113 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [03:55:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [03:55:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:55:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [03:55:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [03:55:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [03:55:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [04:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [04:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [04:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 01/05/2011] id: Previous Weight el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [04:00:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [04:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [04:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [04:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:05:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:05:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:05:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:05:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:05:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 111 u1: BPM st: NotStopd t0: [04:05:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [04:05:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [04:05:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:05:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [04:05:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [04:05:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [04:05:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [04:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [04:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 15.2145 vu: ml t0: [04:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml
t0: [03:10:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:10:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:15:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:15:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:20:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:20:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:25:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:25:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:30:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:30:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:35:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:35:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:40:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:40:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:45:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:45:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:50:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:50:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:55:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:55:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [04:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [04:05:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:05:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 01/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serosanguinous st: NotStopd t0: [01:00:00 01/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 01/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 01/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [01:00:00 01/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [02:00:00 01/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [02:00:00 01/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 01/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [02:00:00 01/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [02:00:00 01/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [02:00:00 01/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [02:00:00 01/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [02:00:00 01/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [02:00:00 01/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [02:00:00 01/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [02:00:00 01/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [02:00:00 01/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [02:00:00 01/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [02:00:00 01/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [02:00:00 01/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [02:00:00 01/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [02:00:00 01/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [02:00:00 01/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [02:00:00 01/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [02:00:00 01/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [02:00:00 01/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [02:00:00 01/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [02:00:00 01/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [02:00:00 01/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 01/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [02:00:00 01/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [02:00:00 01/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serosanguinous st: NotStopd t0: [02:00:00 01/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [02:00:00 01/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [02:00:00 01/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [03:00:00 01/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [03:00:00 01/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 01/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 01/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [03:00:00 01/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:00:00 01/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 01/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 01/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 01/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 01/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 01/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 01/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 01/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [04:00:00 01/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 01/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 01/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 01/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 01/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [04:00:00 01/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [04:00:00 01/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 01/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 01/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [04:00:00 01/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [04:00:00 01/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 01/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 01/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 01/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 01/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 01/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 01/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd
t0: [04:15:00 01/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd t0: [04:15:00 01/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -7 rs: Final st: NotStopd t0: [04:15:00 01/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [04:15:00 01/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 35 u1: mmHg rs: Final st: NotStopd t0: [04:15:00 01/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 98 u1: mmHg rs: Final st: NotStopd t0: [04:15:00 01/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd
t0: [04:00:00 01/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 33.3333 u1: ml/cmH st: NotStopd t0: [04:00:00 01/05/2011] id: RSBI Not Completed el: 0 cu: MICU cg: CRT v1: No Spon Resp st: NotStopd t0: [04:00:00 01/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 01/05/2011] id: high exhale MV el: 0 cu: MICU cg: CRT v1: 18 t0: [04:00:00 01/05/2011] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 01/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 40 u1: cmH2O st: NotStopd t0: [04:00:00 01/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 15 u1: BPM st: NotStopd t0: [04:00:00 01/05/2011] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:2.1 st: NotStopd t0: [04:00:00 01/05/2011] id: Airway Size el: 0 cu: MICU cg: CRT v1: 7.5 mm st: NotStopd t0: [04:00:00 01/05/2011] id: Airway Type el: 0 cu: MICU cg: CRT v1: Endotracheal st: NotStopd t0: [04:00:00 01/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 01/05/2011] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 3 v2: 12 st: NotStopd t0: [04:00:00 01/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 7 st: NotStopd t0: [04:00:00 01/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 01/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 01/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 9 u1: cmH2O st: NotStopd t0: [04:00:00 01/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 11.6 u1: L/min st: NotStopd t0: [04:00:00 01/05/2011] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 01/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [04:00:00 01/05/2011] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [04:00:00 01/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 20 u1: cmH2O st: NotStopd t0: [04:00:00 01/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 16 u1: cmH2O st: NotStopd t0: [04:00:00 01/05/2011] id: Plateau-Off el: 0 cu: MICU cg: CRT v1: Yes st: NotStopd t0: [04:00:00 01/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 0 u1: BPM st: NotStopd t0: [04:00:00 01/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [04:00:00 01/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [04:00:00 01/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 3 u1: cmH2O st: NotStopd t0: [04:00:00 01/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [04:00:00 01/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [04:00:00 01/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [04:00:00 01/05/2011] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [04:00:00 01/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [04:10:00 01/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 14.2 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 14.2 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 32.9 u1: % rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.5 u1: gm/dl rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 319 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.87 u1: /mic l rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 14.2 rs: Final st: NotStopd
t0: [03:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: Frequent st: NotStopd t0: [03:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: PAC's st: NotStopd t0: [04:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: Frequent st: NotStopd t0: [04:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: PAC's st: NotStopd t0: [05:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: Occasional st: NotStopd t0: [05:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: PAC's st: NotStopd t0: [05:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [05:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [05:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [05:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [05:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [05:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [05:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [05:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 15.2145 vu: ml
t0: [05:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [04:10:00 01/05/2011] id: PT el: 0 cu: MICU cg: 1663 v1: 14.1 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 36.2 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 14.1 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 36.2 rs: Final st: NotStopd
t0: [04:10:00 01/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 47 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.5 u1: mg/dl rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 241 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.7 u1: mEq/L rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 47 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.5 u1: mg/dl rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 241 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.7 u1: mEq/L rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd
t0: [04:10:00 01/05/2011] id: Differential-Bands Hematology el: 0 cu: MICU cg: 1663 v1: 15 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Differential-Basos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Differential-Eos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Differential-Lymphs Hematology el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Differential-Monos Hematology el: 0 cu: MICU cg: 1663 v1: 3 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Differential-Polys Hematology el: 0 cu: MICU cg: 1663 v1: 80 rs: Final st: NotStopd
t0: [05:00:00 01/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [05:00:00 01/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [05:00:00 01/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [05:00:00 01/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [05:00:00 01/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [05:00:00 01/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [05:00:00 01/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [05:00:00 01/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [05:00:00 01/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 01/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 01/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [05:00:00 01/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [05:00:00 01/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [05:00:00 01/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 01/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 01/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 01/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [05:00:00 01/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [05:00:00 01/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [05:00:00 01/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [05:00:00 01/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [05:00:00 01/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [05:00:00 01/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serosanguinous st: NotStopd t0: [05:00:00 01/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 01/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [05:00:00 01/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [06:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 01/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [06:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [06:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [06:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [06:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [06:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml t0: [06:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [06:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 15.2145 vu: ml t0: [06:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml
t0: [06:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.11 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [06:00:00 01/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 273 rs: Manual st: NotStopd
t0: [06:00:00 01/05/2011] tf: [08:00:00 09/05/2011] dt: 11640 id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 1570 vu: ml
t0: [06:00:00 01/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [06:00:00 01/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [06:00:00 01/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd
tf: [20:00:00 04/05/2011] pt: Unit Dose rt: SC fr: ASDIR m1: Insulin v1: 0 u1: UNIT
t0: [08:00:00 01/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 35.7143 u1: ml/cmH st: NotStopd t0: [08:00:00 01/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 01/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [08:00:00 01/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 01/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:00:00 01/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [08:00:00 01/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [08:00:00 01/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 01/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 01/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 01/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:00:00 01/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [08:00:00 01/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 01/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 01/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [08:00:00 01/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.2 u1: L/min st: NotStopd t0: [08:00:00 01/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 01/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 01/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [08:00:00 01/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [08:00:00 01/05/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [08:00:00 01/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [08:00:00 01/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [08:00:00 01/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:00:00 01/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 01/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: None st: NotStopd t0: [08:00:00 01/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 509 u1: ml/B st: NotStopd t0: [08:00:00 01/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [08:00:00 01/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 01/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 01/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 01/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 01/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 01/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 01/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 01/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 01/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [08:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 01/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 01/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 01/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 01/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [08:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 01/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 01/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 01/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 01/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [08:00:00 01/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 01/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 01/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 01/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 01/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 01/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [08:00:00 01/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [08:00:00 01/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 01/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 01/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [08:00:00 01/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [08:00:00 01/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 01/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 01/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 01/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 01/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 01/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [08:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [08:00:00 01/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [08:00:00 01/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 01/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 01/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 01/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 01/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [08:00:00 01/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 01/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 01/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 01/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 01/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 01/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 01/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [08:00:00 01/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 01/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 01/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 01/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 01/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 01/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [08:00:00 01/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [08:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [08:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20.8656 vu: ml t0: [08:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 23.9085 vu: ml t0: [08:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml
t0: [08:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.073614 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:35:00 01/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 54.8246 u1: units st: NotStopd t0: [08:35:00 01/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 54.8246 u1: units st: NotStopd t0: [08:35:00 01/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [08:35:00 01/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.456 u1: L st: NotStopd
t0: [04:10:00 01/05/2011] id: Total Protein Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [04:10:00 01/05/2011] id: Total Protein(6.5-8) Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd
t0: [08:35:00 01/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:35:00 01/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.2 u1: L/min st: NotStopd t0: [08:35:00 01/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 0 u1: cmH2O st: NotStopd t0: [08:35:00 01/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [08:35:00 01/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [08:35:00 01/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 502 u1: ml/B st: NotStopd t0: [08:35:00 01/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Support st: NotStopd
t0: [08:00:00 01/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [09:05:00 01/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.28 rs: Final st: NotStopd t0: [09:05:00 01/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -7 rs: Final st: NotStopd t0: [09:05:00 01/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [09:05:00 01/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 38 u1: mmHg rs: Final st: NotStopd t0: [09:05:00 01/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 99 u1: mmHg rs: Final st: NotStopd t0: [09:05:00 01/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.28 rs: Final st: NotStopd
t0: [09:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [09:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [09:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [09:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [09:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [09:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [09:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [09:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 8 vu: ml t0: [09:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 42 vu: ml
t0: [09:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.056 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:40:00 01/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [09:40:00 01/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 10 u1: . st: NotStopd
t0: [10:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [10:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [10:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [10:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [10:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [10:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.037 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [09:00:00 02/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 10 dn: 1 m1: Potassium Chloride v1: 20 u1: mEq
t0: [10:30:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:30:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:30:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:30:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [10:30:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:30:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [10:30:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [10:30:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:30:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [10:30:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [10:30:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:30:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:30:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0184035 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:30:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [10:30:00 01/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [10:30:00 01/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [10:30:00 01/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd
t0: [11:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [11:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [11:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [11:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 01/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 57.9 u1: kg st: NotStopd t0: [11:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [11:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [11:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 01/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 161 rs: Manual st: NotStopd
t0: [12:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [12:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [12:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [12:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [12:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 9.09629 vu: ml st: Stopped t0: [12:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [12:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 30 vu: ml t0: [12:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 31.2984 vu: ml t0: [12:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 140 vu: ml
t0: [12:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:40:00 01/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:00:00 01/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 01/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [12:00:00 01/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 01/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [12:00:00 01/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [12:00:00 01/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 01/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 01/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 01/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [12:00:00 01/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [12:00:00 01/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 01/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 01/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [12:00:00 01/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.7 u1: L/min st: NotStopd t0: [12:00:00 01/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 01/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 01/05/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [12:00:00 01/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 10 u1: . st: NotStopd t0: [12:00:00 01/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [12:00:00 01/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:00:00 01/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: None st: NotStopd t0: [12:00:00 01/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 536 u1: ml/B st: NotStopd t0: [12:00:00 01/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:00:00 01/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [13:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [13:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [13:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [13:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [13:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [13:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml
t0: [13:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [13:00:00 01/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd
t0: [14:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [14:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 103 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [14:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [14:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [14:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [14:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [14:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [14:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20.8656 vu: ml t0: [14:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml
t0: [14:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:09:00 01/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd t0: [16:09:00 01/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -5 rs: Final st: NotStopd t0: [16:09:00 01/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [16:09:00 01/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 34 u1: mmHg rs: Final st: NotStopd t0: [16:09:00 01/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 111 u1: mmHg rs: Final st: NotStopd t0: [16:09:00 01/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd
t0: [16:15:00 01/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:15:00 01/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [16:15:00 01/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:15:00 01/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [16:15:00 01/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [16:15:00 01/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:15:00 01/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [16:15:00 01/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [16:15:00 01/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:15:00 01/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [16:15:00 01/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:15:00 01/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:15:00 01/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [16:15:00 01/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.7 u1: L/min st: NotStopd t0: [16:15:00 01/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:15:00 01/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:15:00 01/05/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [16:15:00 01/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 10 u1: . st: NotStopd t0: [16:15:00 01/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [16:15:00 01/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:15:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [16:15:00 01/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [16:15:00 01/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [16:15:00 01/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 461 u1: ml/B st: NotStopd t0: [16:15:00 01/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:15:00 01/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [14:00:00 01/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 23.5 rs: Final st: NotStopd
t0: [16:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [16:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [16:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [16:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [16:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [16:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 01/05/2011] id: ETT Position Change el: 0 cu: MICU cg: RRT v1: Done st: NotStopd
t0: [16:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:00:00 30/04/2011] id: Previous WeightF el: 0 cu: MICU cg: RN u1: kg st: NotStopd t0: [17:00:00 01/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [17:00:00 01/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd
t0: [14:00:00 01/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [17:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [17:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 30 vu: ml t0: [17:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 31.2984 vu: ml t0: [17:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml
t0: [17:00:00 01/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [17:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [17:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [17:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [17:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [17:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [17:00:00 01/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [17:00:00 01/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [17:00:00 01/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [17:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 01/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [18:00:00 01/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 01/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [18:00:00 01/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 01/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [18:00:00 01/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [18:00:00 01/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [18:00:00 01/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Fam Talked to RN st: NotStopd t0: [18:00:00 01/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [18:00:00 01/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 01/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [18:00:00 01/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [18:00:00 01/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [18:00:00 01/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [18:00:00 01/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [18:00:00 01/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 01/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 01/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [18:00:00 01/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [18:00:00 01/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [18:00:00 01/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [18:00:00 01/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 01/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 01/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 01/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 01/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 01/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [18:00:00 01/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 01/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 01/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 01/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 01/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [18:00:00 01/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [18:00:00 01/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [18:00:00 01/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [18:00:00 01/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 159 rs: Manual st: NotStopd t0: [18:00:00 01/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [18:00:00 01/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [18:00:00 01/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [18:00:00 01/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [18:00:00 01/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [18:00:00 01/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [18:00:00 01/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [18:00:00 01/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [18:00:00 01/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [18:00:00 01/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Straw st: NotStopd t0: [18:00:00 01/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [18:00:00 01/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [18:00:00 01/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [18:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [18:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [18:00:00 01/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 150 vu: ml
t0: [17:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 01/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 1720 ap: none
t0: [17:00:00 01/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 30.7 u1: % rs: Final st: NotStopd
t0: [18:15:00 01/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 26.3158 u1: ml/cmH st: NotStopd t0: [18:15:00 01/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [18:15:00 01/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [18:15:00 01/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [18:15:00 01/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [18:15:00 01/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [18:15:00 01/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [18:15:00 01/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [18:15:00 01/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [18:15:00 01/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [18:15:00 01/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [18:15:00 01/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [18:15:00 01/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [18:15:00 01/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [18:15:00 01/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [18:15:00 01/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [18:15:00 01/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [18:15:00 01/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [18:15:00 01/05/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [18:15:00 01/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [18:15:00 01/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [18:15:00 01/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [18:15:00 01/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [18:15:00 01/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 515 u1: ml/B st: NotStopd t0: [18:15:00 01/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [18:15:00 01/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [18:15:00 01/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [18:15:00 01/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [18:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 101 u1: BPM st: NotStopd t0: [18:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [18:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [18:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [18:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [18:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:05:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:05:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:05:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:05:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:05:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:05:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:05:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 123 u1: BPM st: NotStopd t0: [18:05:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:05:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [18:05:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [18:05:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:05:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [18:05:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [18:05:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:10:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:10:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:10:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:10:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:10:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 119 u1: BPM st: NotStopd t0: [18:10:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 73 u1: mmHg v2: 42 u2: mmHg st: NotStopd t0: [18:10:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 54 u1: mmHg st: NotStopd t0: [18:10:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:10:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [18:10:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [18:10:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:15:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:15:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:15:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:15:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:15:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:15:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:15:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 119 u1: BPM st: NotStopd t0: [18:15:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:15:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 67 u1: mmHg v2: 40 u2: mmHg st: NotStopd t0: [18:15:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 50 u1: mmHg st: NotStopd t0: [18:15:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:15:00 01/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: EKG st: NotStopd t0: [18:15:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [18:15:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [18:15:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [18:05:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:05:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [18:10:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0920175 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:10:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [18:15:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0920175 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:15:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [18:30:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:30:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:30:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [18:30:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:30:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [18:30:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [18:30:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:30:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:30:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [18:30:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:30:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0920175 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:30:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [19:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 01/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [19:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 01/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [19:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [19:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 01/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [19:00:00 01/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [19:00:00 01/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [19:00:00 01/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [19:00:00 01/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [19:00:00 01/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [19:00:00 01/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [19:00:00 01/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [19:00:00 01/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [19:00:00 01/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [19:00:00 01/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [19:00:00 01/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [19:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 113 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [19:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [19:00:00 01/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [19:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [19:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 88 u1: % st: NotStopd t0: [19:00:00 01/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [19:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [19:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [19:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [19:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml
t0: [19:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0920175 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 116 u1: BPM st: NotStopd t0: [20:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [20:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [20:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [20:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [20:00:00 01/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 01/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [20:00:00 01/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [20:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [20:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [20:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 75 vu: ml
t0: [20:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0920175 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [19:45:00 01/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [19:45:00 01/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [19:45:00 01/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -4 rs: Final st: NotStopd t0: [19:45:00 01/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [19:45:00 01/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 35 u1: mmHg rs: Final st: NotStopd t0: [19:45:00 01/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 75 u1: mmHg rs: Final st: NotStopd t0: [19:45:00 01/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [19:45:00 01/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd
t0: [20:00:00 01/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 27.7778 u1: ml/cmH st: NotStopd t0: [20:00:00 01/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 01/05/2011] id: high exhale MV el: 0 cu: MICU cg: CRT v1: 18 t0: [20:00:00 01/05/2011] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 01/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 01/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 01/05/2011] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:2.1 st: NotStopd t0: [20:00:00 01/05/2011] id: Airway Size el: 0 cu: MICU cg: CRT v1: 7.5 mm st: NotStopd t0: [20:00:00 01/05/2011] id: Airway Type el: 0 cu: MICU cg: CRT v1: Endotracheal st: NotStopd t0: [20:00:00 01/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35.4 u1: Deg. C st: NotStopd t0: [20:00:00 01/05/2011] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 3 v2: 12 st: NotStopd t0: [20:00:00 01/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 7 st: NotStopd t0: [20:00:00 01/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 01/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 01/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 12 u1: cmH2O st: NotStopd t0: [20:00:00 01/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 12.4 u1: L/min st: NotStopd t0: [20:00:00 01/05/2011] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 01/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [20:00:00 01/05/2011] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [20:00:00 01/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 23 u1: cmH2O st: NotStopd t0: [20:00:00 01/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 01/05/2011] id: Plateau-Off el: 0 cu: MICU cg: CRT v1: Yes st: NotStopd t0: [20:00:00 01/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 6 u1: BPM st: NotStopd t0: [20:00:00 01/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 01/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [20:00:00 01/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 01/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 537 u1: ml/B st: NotStopd t0: [20:00:00 01/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [20:00:00 01/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [20:00:00 01/05/2011] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [20:00:00 01/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [20:00:00 01/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [20:00:00 01/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd
t0: [20:00:00 01/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 250 vu: ml
t0: [20:00:00 01/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 01/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [21:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [21:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 113 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [21:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [21:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [21:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [21:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 01/05/2011] tf: [14:07:00 24/05/2011] dt: 32767 id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 5.4 vu: ml t0: [21:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [21:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [21:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 5.4 vu: ml t0: [21:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml
t0: [21:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.05 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:00:00 01/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 01/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 01/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 01/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 01/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [20:00:00 01/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 01/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 01/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 01/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 01/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 01/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Soft st: NotStopd t0: [20:00:00 01/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [20:00:00 01/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [20:00:00 01/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [22:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 01/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [22:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [22:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 113 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [22:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [22:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [22:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [22:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [22:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [22:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 5.43375 vu: ml t0: [22:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 20 vu: ml
t0: [22:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.05 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 01/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 01/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 01/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 01/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 01/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 01/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 01/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [23:00:00 01/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 01/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [23:00:00 01/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [23:00:00 01/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 01/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [23:00:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 01/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 01/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [23:00:00 01/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 01/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [23:00:00 01/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 5.43375 vu: ml t0: [23:00:00 01/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml
t0: [23:00:00 01/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 01/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 01/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 25.8666 cv: 1917.95 ap: none t0: [23:00:00 01/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 45.8666 cv: 2267.95 ap: none t0: [23:00:00 01/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 20 cv: 350 ap: none t0: [23:00:00 01/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 40 cv: 967 ap: none
t0: [23:30:00 01/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 31.25 u1: ml/cmH st: NotStopd t0: [23:30:00 01/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [23:30:00 01/05/2011] id: high exhale MV el: 0 cu: MICU cg: CRT v1: 18 t0: [23:30:00 01/05/2011] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [23:30:00 01/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 45 u1: cmH2O st: NotStopd t0: [23:30:00 01/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 20 u1: BPM st: NotStopd t0: [23:30:00 01/05/2011] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:2.1 st: NotStopd t0: [23:30:00 01/05/2011] id: Airway Size el: 0 cu: MICU cg: CRT v1: 7.5 mm st: NotStopd t0: [23:30:00 01/05/2011] id: Airway Type el: 0 cu: MICU cg: CRT v1: Endotracheal st: NotStopd t0: [23:30:00 01/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35 u1: Deg. C st: NotStopd t0: [23:30:00 01/05/2011] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 3 v2: 12 st: NotStopd t0: [23:30:00 01/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 7 st: NotStopd t0: [23:30:00 01/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [23:30:00 01/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [23:30:00 01/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 9 u1: cmH2O st: NotStopd t0: [23:30:00 01/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 12 u1: L/min st: NotStopd t0: [23:30:00 01/05/2011] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [23:30:00 01/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [23:30:00 01/05/2011] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [23:30:00 01/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 21 u1: cmH2O st: NotStopd t0: [23:30:00 01/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 15 u1: cmH2O st: NotStopd t0: [23:30:00 01/05/2011] id: Plateau-Off el: 0 cu: MICU cg: CRT v1: Yes st: NotStopd t0: [23:30:00 01/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 0 u1: BPM st: NotStopd t0: [23:30:00 01/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [23:30:00 01/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [23:30:00 01/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 3 u1: cmH2O st: NotStopd t0: [23:30:00 01/05/2011] id: SpO2 el: 0 cu: MICU cg: CRT v1: 97 u1: % st: NotStopd t0: [23:30:00 01/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 508 u1: ml/B st: NotStopd t0: [23:30:00 01/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [23:30:00 01/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [23:30:00 01/05/2011] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [23:30:00 01/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [00:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [00:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 103 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [00:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [00:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [00:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [00:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [00:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [00:00:00 02/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 4.347 vu: ml t0: [00:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml
t0: [00:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 02/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [00:00:00 02/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 02/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 02/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3889 u1: Deg. C st: NotStopd t0: [00:00:00 02/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.5 u1: Deg. F st: NotStopd
t0: [00:00:00 02/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 157 rs: Manual st: NotStopd
t0: [20:00:00 01/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 01/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 01/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [21:00:00 01/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [21:00:00 01/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 01/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [21:00:00 01/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [21:00:00 01/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [21:00:00 01/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [21:00:00 01/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [21:00:00 01/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 01/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [21:00:00 01/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 01/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [21:00:00 01/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [21:00:00 01/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [21:00:00 01/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 01/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 02/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 02/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 02/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 02/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 02/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 02/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 02/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 02/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 02/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 02/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 02/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 02/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 02/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 02/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [00:00:00 02/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 02/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 02/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 02/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 02/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 02/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [00:00:00 02/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [00:00:00 02/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 02/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 02/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 02/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 02/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 02/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 02/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 02/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 02/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 02/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 02/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 02/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 02/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 02/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 02/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [00:00:00 02/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 02/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 02/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [00:00:00 02/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 02/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 02/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [00:00:00 02/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Straw st: NotStopd t0: [00:00:00 02/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 02/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [00:00:00 02/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [20:00:00 01/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Large t0: [00:00:00 02/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Large
t0: [00:00:00 02/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.03 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 01/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 40 cv: 40 ap: none t0: [23:00:00 01/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 5.86655 cv: 5.86655 ap: none t0: [23:00:00 01/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward t0: [23:00:00 01/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 5.86655 cv: -419.046 ap: carryForward t0: [23:00:00 01/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 40 cv: 2687 ap: carryForward t0: [23:00:00 01/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 5.86655 cv: 6525.21 ap: carryForward
t0: [01:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [01:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [01:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [01:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [01:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [02:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [02:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [02:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [02:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [01:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [01:00:00 02/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 3.26025 vu: ml t0: [01:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [02:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [02:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [02:00:00 02/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 3.26025 vu: ml t0: [02:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml
t0: [01:00:00 02/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.03 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [02:00:00 02/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.03 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [03:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [03:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [03:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [03:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 02/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.03 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [02:00:00 02/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [03:00:00 02/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [03:00:00 02/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 02/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [03:00:00 02/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 02/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 02/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [03:00:00 02/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:00:00 02/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [03:00:00 02/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [03:00:00 02/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [03:00:00 02/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 02/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 02/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 02/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 02/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [04:00:00 02/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 02/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 02/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 02/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 02/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [04:00:00 02/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [04:00:00 02/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd
t0: [03:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [03:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [03:00:00 02/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 3.26025 vu: ml t0: [04:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [04:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [04:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [04:00:00 02/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 3.26025 vu: ml
t0: [00:00:00 02/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 02/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 02/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 02/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 02/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [00:00:00 02/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [00:00:00 02/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 02/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 02/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 02/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 02/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 02/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 02/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 02/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 02/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 02/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 02/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 02/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 02/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [00:00:00 02/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 02/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [00:00:00 02/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [02:00:00 02/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [02:00:00 02/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [03:00:00 02/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [03:00:00 02/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [03:00:00 02/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [03:00:00 02/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [03:00:00 02/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [03:00:00 02/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [03:00:00 02/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [03:00:00 02/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [03:00:00 02/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [03:00:00 02/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [03:00:00 02/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [03:00:00 02/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [03:00:00 02/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [03:00:00 02/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [03:00:00 02/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [03:00:00 02/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [03:00:00 02/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [03:00:00 02/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [03:00:00 02/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [03:00:00 02/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [03:00:00 02/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [03:00:00 02/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [03:00:00 02/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [03:00:00 02/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [03:00:00 02/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [03:00:00 02/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [03:00:00 02/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [03:00:00 02/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [03:00:00 02/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [03:00:00 02/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [03:00:00 02/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [03:00:00 02/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [03:00:00 02/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [03:00:00 02/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [03:00:00 02/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [03:00:00 02/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [03:00:00 02/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [03:00:00 02/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [03:00:00 02/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [03:00:00 02/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [03:00:00 02/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [03:00:00 02/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [04:00:00 02/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 27.7778 u1: ml/cmH st: NotStopd t0: [04:00:00 02/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: CRT v1: 140 u1: units st: NotStopd t0: [04:00:00 02/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 02/05/2011] id: high exhale MV el: 0 cu: MICU cg: CRT v1: 18 t0: [04:00:00 02/05/2011] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 02/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 45 u1: cmH2O st: NotStopd t0: [04:00:00 02/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 02/05/2011] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:2.1 st: NotStopd t0: [04:00:00 02/05/2011] id: Airway Size el: 0 cu: MICU cg: CRT v1: 7.5 mm st: NotStopd t0: [04:00:00 02/05/2011] id: Airway Type el: 0 cu: MICU cg: CRT v1: Endotracheal st: NotStopd t0: [04:00:00 02/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 02/05/2011] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 3 v2: 12 st: NotStopd t0: [04:00:00 02/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 7 st: NotStopd t0: [04:00:00 02/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 02/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 02/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 12 u1: cmH2O st: NotStopd t0: [04:00:00 02/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 13.8 u1: L/min st: NotStopd t0: [04:00:00 02/05/2011] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 02/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [04:00:00 02/05/2011] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [04:00:00 02/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 23 u1: cmH2O st: NotStopd t0: [04:00:00 02/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 19 u1: cmH2O st: NotStopd t0: [04:00:00 02/05/2011] id: Plateau-Off el: 0 cu: MICU cg: CRT v1: Yes st: NotStopd t0: [04:00:00 02/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: CRT v1: 140 u1: units st: NotStopd t0: [04:00:00 02/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 5 u1: BPM st: NotStopd t0: [04:00:00 02/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 29 u1: BPM st: NotStopd t0: [04:00:00 02/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 24 u1: BPM st: NotStopd t0: [04:00:00 02/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 3 u1: cmH2O st: NotStopd t0: [04:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: CRT v1: 99 u1: % st: NotStopd t0: [04:00:00 02/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: CRT v1: 35 u1: BPM st: NotStopd t0: [04:00:00 02/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: CRT v1: 0.25 u1: L st: NotStopd t0: [04:00:00 02/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [04:00:00 02/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [04:00:00 02/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [04:00:00 02/05/2011] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [04:00:00 02/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [04:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [04:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [04:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [04:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [04:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [04:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml
t0: [04:00:00 02/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.03 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [04:22:00 02/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.37 rs: Final st: NotStopd t0: [04:22:00 02/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [04:22:00 02/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -5 rs: Final st: NotStopd t0: [04:22:00 02/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [04:22:00 02/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 31 u1: mmHg rs: Final st: NotStopd t0: [04:22:00 02/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 94 u1: mmHg rs: Final st: NotStopd t0: [04:22:00 02/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.37 rs: Final st: NotStopd t0: [04:22:00 02/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd
t0: [04:00:00 02/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 10.7 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 10.7 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 30.2 u1: % rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.9 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 386 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.55 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 10.7 rs: Final st: NotStopd
t0: [05:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [05:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [05:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [05:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [05:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [05:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [05:00:00 02/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 3.26025 vu: ml t0: [05:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 25 vu: ml
t0: [05:00:00 02/05/2011] id: Levophed-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.03 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [04:00:00 02/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 54 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 113 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 159 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.9 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 141 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 54 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 113 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 159 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.9 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [04:00:00 02/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 141 rs: Final st: NotStopd
t0: [06:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [06:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [06:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [06:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [06:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 02/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 154 rs: Manual st: NotStopd
t0: [06:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [06:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [06:00:00 02/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 3.26025 vu: ml t0: [06:00:00 02/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 125 vu: ml t0: [06:00:00 02/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Medium t0: [06:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml
t0: [06:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 02/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [04:00:00 02/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 25.1 rs: Final st: NotStopd
t0: [06:00:00 02/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [07:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 02/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [07:00:00 02/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [07:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [07:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [07:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [07:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 02/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [07:00:00 02/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [07:00:00 02/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [07:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
id: Gastric Meds el: 1 cu: MICU cg: RN io: Gastric Meds PO/Gastric du: ml rt: Gastric/Feeding Tube id: TF Residual el: 1 cu: MICU cg: RN io: TF Residual Gastric/TF Residual du: ml rt: Gastric/Feeding Tube
t0: [08:00:00 02/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 02/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 02/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 02/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [08:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [08:00:00 02/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 02/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 02/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 02/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 02/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 02/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 02/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 02/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 02/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 02/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 02/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 02/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 02/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 02/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [08:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 02/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 02/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 02/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 02/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 02/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [08:00:00 02/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 02/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 02/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 02/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 02/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 02/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 02/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [08:00:00 02/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [08:00:00 02/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 02/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 02/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 02/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 02/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [08:00:00 02/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [08:00:00 02/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 02/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 02/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 02/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [08:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [08:00:00 02/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 02/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 02/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 02/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 02/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 02/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [08:00:00 02/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 02/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 02/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 02/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [08:00:00 02/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 02/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 02/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [08:00:00 02/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [08:00:00 02/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 02/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:00:00 02/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [08:00:00 02/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 02/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 02/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 02/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [08:00:00 02/05/2011] tf: [08:00:00 05/05/2011] dt: 4320 id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [08:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [08:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 24.3432 vu: ml t0: [08:00:00 02/05/2011] tf: [14:07:00 24/05/2011] dt: 32047 id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [08:00:00 02/05/2011] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: MICU cg: RN ai: 189 vo: 6.5205 vu: ml t0: [08:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml
t0: [07:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [08:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 02/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 30 ap: none
t0: [08:00:00 02/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 31.25 u1: ml/cmH st: NotStopd t0: [08:00:00 02/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 02/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [08:00:00 02/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 02/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:00:00 02/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:00:00 02/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 02/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 02/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [08:00:00 02/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:00:00 02/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [08:00:00 02/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 02/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 02/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:00:00 02/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.6 u1: L/min st: NotStopd t0: [08:00:00 02/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 02/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 02/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [08:00:00 02/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [08:00:00 02/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [08:00:00 02/05/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [08:00:00 02/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:00:00 02/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [08:00:00 02/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:00:00 02/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 02/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [08:00:00 02/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 02/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 450 u1: ml/B st: NotStopd t0: [08:00:00 02/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [08:00:00 02/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 02/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 02/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 02/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [08:00:00 02/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [08:00:00 02/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [08:00:00 02/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [08:00:00 02/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [08:00:00 02/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 02/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [08:00:00 02/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [08:00:00 02/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 02/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd
t0: [08:00:00 02/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 40 vu: ml
t0: [08:00:00 02/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 02/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 02/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 02/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [08:00:00 02/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [09:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [09:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [09:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [09:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [09:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:00:00 02/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [08:00:00 02/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 02/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 02/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 02/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 02/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 02/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 02/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 02/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 02/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 02/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [09:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [09:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [09:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml
t0: [10:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [10:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [10:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [10:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [10:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [10:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [10:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [10:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml
t0: [10:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [11:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [11:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [11:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [11:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [11:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [11:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [11:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml
t0: [11:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [10:00:00 02/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [10:00:00 02/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 02/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 02/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 02/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 02/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 02/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 02/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 02/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 02/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 02/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 02/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 02/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 02/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Change in Vitals st: NotStopd t0: [12:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [12:00:00 02/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 02/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 02/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 02/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 02/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 02/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 02/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 02/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 02/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 02/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 02/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [12:00:00 02/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 02/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 02/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 02/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [12:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 02/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [12:00:00 02/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 02/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 02/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 02/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [12:00:00 02/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 02/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 02/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 02/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 02/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 02/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 02/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [12:00:00 02/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [12:00:00 02/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 02/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 02/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 02/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 02/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [12:00:00 02/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [12:00:00 02/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 02/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 02/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 02/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [12:00:00 02/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [12:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [12:00:00 02/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [12:00:00 02/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 02/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 02/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 02/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 02/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 02/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [12:00:00 02/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 02/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 02/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 02/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 02/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 02/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [12:00:00 02/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 02/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 02/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 02/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 02/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 02/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [12:00:00 02/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [12:00:00 02/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [12:00:00 02/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [12:00:00 02/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [12:00:00 02/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [12:00:00 02/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 02/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 02/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [12:00:00 02/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 02/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [12:00:00 02/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [12:00:00 02/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 02/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [12:00:00 02/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [11:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml t0: [12:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [12:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [12:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [12:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml
t0: [12:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 02/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 158 rs: Manual st: NotStopd
tf: [12:00:00 02/05/2011] pt: Unit Dose rt: IV DRIP fr: TITRATE TO m1: Propofol (Generic) v1: 1000 u1: mg
t0: [12:00:00 02/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 23.8095 u1: ml/cmH st: NotStopd t0: [12:00:00 02/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 02/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [12:00:00 02/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 02/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [12:00:00 02/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [12:00:00 02/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 02/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 02/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.6 u1: Deg. C st: NotStopd t0: [12:00:00 02/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [12:00:00 02/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [12:00:00 02/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 02/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 02/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:00:00 02/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 16.3 u1: L/min st: NotStopd t0: [12:00:00 02/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 02/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 02/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [12:00:00 02/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [12:00:00 02/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [12:00:00 02/05/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [12:00:00 02/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [12:00:00 02/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [12:00:00 02/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [12:00:00 02/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:00:00 02/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 495 u1: ml/B st: NotStopd t0: [12:00:00 02/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [12:00:00 02/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:00:00 02/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 02/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [12:00:00 02/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [12:00:00 02/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [12:00:00 02/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [12:00:00 02/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd
tf: [16:00:00 10/05/2011] pt: Unit Dose rt: IV DRIP fr: TITRATE TO m1: Propofol (Generic) v1: 1000 u1: mg tf: [12:00:00 16/05/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Midazolam HCl v1: 50 u1: mg m2: D5W v2: 50 u2: ml
t0: [13:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [13:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [13:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [13:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [13:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [13:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [13:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [14:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [14:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [14:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [14:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [14:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [14:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 02/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 15 vu: ml t0: [13:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [13:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [13:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [14:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [14:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [14:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 65 vu: ml
t0: [13:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [14:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [15:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [15:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [15:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 103 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [15:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [15:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [15:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [15:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [15:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [15:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [15:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml
t0: [15:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [14:00:00 02/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [14:00:00 02/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 02/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 02/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 02/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 02/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 02/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 02/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 02/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 02/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd
id: Midazolam el: 100 cu: MICU 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: MICU cg: RN io: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions vo: 50 du: ml rt: Intravenous Push
t0: [15:30:00 02/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [15:30:00 02/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [15:30:00 02/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [15:30:00 02/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [15:30:00 02/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [15:30:00 02/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [15:30:00 02/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [15:30:00 02/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13 u1: L/min st: NotStopd t0: [15:30:00 02/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [15:30:00 02/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 10 u1: . st: NotStopd t0: [15:30:00 02/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [15:30:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [15:30:00 02/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 460 u1: ml/B st: NotStopd t0: [15:30:00 02/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [15:30:00 02/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [16:00:00 02/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 02/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [16:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [16:00:00 02/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 02/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 02/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 02/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 02/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 02/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 02/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 02/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [16:00:00 02/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [16:00:00 02/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 02/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [16:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 02/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 02/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 02/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [16:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [16:00:00 02/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 02/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [16:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [16:00:00 02/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 02/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [16:00:00 02/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [16:00:00 02/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [16:00:00 02/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 02/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [16:00:00 02/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [16:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [16:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [16:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [16:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [16:00:00 02/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 0 vu: ml nb: 1
t0: [16:00:00 02/05/2011] tf: [14:07:00 24/05/2011] dt: 31567 id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:15:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:15:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [16:15:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:15:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:15:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:15:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:15:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:15:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [16:15:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:15:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [16:15:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [16:15:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:15:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [16:15:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [16:15:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:15:00 02/05/2011] 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: [16:15:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:14:00 02/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 29.4118 u1: ml/cmH st: NotStopd t0: [16:14:00 02/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:14:00 02/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [16:14:00 02/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:14:00 02/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [16:14:00 02/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [16:14:00 02/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:14:00 02/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [16:14:00 02/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:14:00 02/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:14:00 02/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [16:14:00 02/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:14:00 02/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:14:00 02/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [16:14:00 02/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.1 u1: L/min st: NotStopd t0: [16:14:00 02/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:14:00 02/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:14:00 02/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [16:14:00 02/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [16:14:00 02/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [16:14:00 02/05/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [16:14:00 02/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [16:14:00 02/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [16:14:00 02/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [16:14:00 02/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:14:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [16:14:00 02/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: None st: NotStopd t0: [16:14:00 02/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 520 u1: ml/B st: NotStopd t0: [16:14:00 02/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [16:14:00 02/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [16:14:00 02/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:14:00 02/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [16:00:00 02/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 02/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 02/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 02/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 02/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 02/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 02/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 02/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 02/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 02/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [16:00:00 02/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 02/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 02/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 02/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 02/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 02/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 02/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [16:00:00 02/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [16:00:00 02/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 02/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 02/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 02/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 02/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [16:00:00 02/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [16:00:00 02/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [16:00:00 02/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 02/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 02/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [16:00:00 02/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 02/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 02/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 02/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [16:00:00 02/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [16:00:00 02/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 02/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 02/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 02/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 02/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 02/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 02/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 02/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [16:00:00 02/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 02/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 02/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [16:00:00 02/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 02/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 02/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [16:00:00 02/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 02/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [16:00:00 02/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 02/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 02/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 02/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [16:00:00 02/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [16:00:00 02/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 02/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [17:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [17:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [17:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [17:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [17:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [17:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [17:00:00 02/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [17:00:00 02/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [17:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [17:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [17:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml t0: [17:00:00 02/05/2011] tf: [07:30:00 18/05/2011] dt: 22470 id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 0.875 vu: ml
t0: [17:00:00 02/05/2011] 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: [17:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [17:00:00 02/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 60 vu: ml
t0: [23:00:00 02/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 225 ap: none
tf: [17:00:00 03/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 18 dn: 1 m1: Furosemide v1: 20 u1: mg
t0: [18:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [18:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [18:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [18:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [18:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [18:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 02/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 137 rs: Manual st: NotStopd
t0: [18:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [18:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [18:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 55 vu: ml t0: [18:00:00 02/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [18:00:00 02/05/2011] 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: [18:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:00:00 02/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 02/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [20:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 02/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 02/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Other Remarks st: NotStopd t0: [20:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [20:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [20:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [20:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [20:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [20:00:00 02/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 02/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [20:00:00 02/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [20:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 100 vu: ml t0: [20:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [20:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 27.8208 vu: ml t0: [20:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml t0: [20:00:00 02/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [20:00:00 02/05/2011] 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: [20:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:00:00 02/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [20:00:00 02/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd
t0: [20:30:00 02/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 31.25 u1: ml/cmH st: NotStopd t0: [20:30:00 02/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:30:00 02/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [20:30:00 02/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:30:00 02/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [20:30:00 02/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [20:30:00 02/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [20:30:00 02/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:30:00 02/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [20:30:00 02/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:30:00 02/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:30:00 02/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [20:30:00 02/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:30:00 02/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:30:00 02/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [20:30:00 02/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.5 u1: L/min st: NotStopd t0: [20:30:00 02/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:30:00 02/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:30:00 02/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [20:30:00 02/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [20:30:00 02/05/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [20:30:00 02/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [20:30:00 02/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [20:30:00 02/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [20:30:00 02/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:30:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 95 u1: % st: NotStopd t0: [20:30:00 02/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 490 u1: ml/B st: NotStopd t0: [20:30:00 02/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [20:30:00 02/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:30:00 02/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:30:00 02/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 02/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 02/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 02/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 02/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 02/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 02/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 02/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 02/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 02/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [20:00:00 02/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 02/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 02/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 02/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Hematoma st: NotStopd t0: [20:00:00 02/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 02/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [20:00:00 02/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 02/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [20:00:00 02/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [20:00:00 02/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [20:00:00 02/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 02/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 02/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 02/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 02/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 02/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 02/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 02/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [20:00:00 02/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 02/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 02/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 02/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 02/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 02/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 02/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [20:00:00 02/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 02/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 02/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 02/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 02/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [20:00:00 02/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 02/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 02/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 02/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [20:00:00 02/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 02/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 02/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 02/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 02/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 02/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 02/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 02/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 02/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [20:00:00 02/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 02/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [20:00:00 02/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [20:00:00 02/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 02/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [20:00:00 02/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [21:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 02/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [21:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 02/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [21:00:00 02/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 02/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [21:00:00 02/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 02/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [21:00:00 02/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 02/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [21:00:00 02/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 02/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 02/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 02/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [21:00:00 02/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [21:00:00 02/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 02/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 02/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 02/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [21:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [21:00:00 02/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [21:00:00 02/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [21:00:00 02/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [21:00:00 02/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [21:00:00 02/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [21:00:00 02/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [21:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [21:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 130 vu: ml t0: [21:00:00 02/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [21:00:00 02/05/2011] 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: [21:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [22:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [22:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 86 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [22:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [22:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [22:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [22:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 02/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 02/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 02/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 02/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 02/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 02/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 02/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [23:00:00 02/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 02/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 96 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [23:00:00 02/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [23:00:00 02/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 02/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [23:00:00 02/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [23:00:00 02/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [22:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [22:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [22:00:00 02/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml t0: [23:00:00 02/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [23:00:00 02/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 02/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [23:00:00 02/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [23:00:00 02/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [22:00:00 02/05/2011] 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: [22:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [23:00:00 02/05/2011] 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: [23:00:00 02/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 02/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 40 cv: 40 ap: none t0: [23:00:00 02/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 34.9104 cv: 34.9104 ap: none t0: [23:00:00 02/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 24.9104 cv: 1183.33 ap: none t0: [23:00:00 02/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 74.9104 cv: 2173.33 ap: none t0: [23:00:00 02/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 50 cv: 960 ap: none t0: [23:00:00 02/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 40 cv: 1265 ap: none t0: [23:00:00 02/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 34.9104 cv: 683.333 ap: carryForward t0: [23:00:00 02/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 40 cv: 1490 ap: carryForward t0: [23:00:00 02/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 34.9104 cv: 7208.54 ap: carryForward
t0: [00:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [00:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [00:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml t0: [00:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [22:00:00 02/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 02/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 02/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 02/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [22:00:00 02/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [22:00:00 02/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [22:00:00 02/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 02/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 02/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 02/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 02/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 02/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [22:00:00 02/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 02/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 03/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 03/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 03/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [00:00:00 03/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 03/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 03/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 03/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 03/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 03/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [00:00:00 03/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 03/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [00:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 03/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 03/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 03/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [00:00:00 03/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [00:00:00 03/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [00:00:00 03/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [00:00:00 03/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 03/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 03/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 03/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 98 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [00:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [00:00:00 03/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 03/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [00:00:00 03/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [00:00:00 03/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 03/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 03/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [00:00:00 03/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 03/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 03/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [00:00:00 03/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [00:00:00 03/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 03/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 03/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 03/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 03/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [00:00:00 03/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [00:00:00 03/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 03/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [00:00:00 03/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 03/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 03/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [00:00:00 03/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [00:00:00 03/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 03/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [00:00:00 03/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [00:00:00 03/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [00:00:00 03/05/2011] 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: [00:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 03/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 151 rs: Manual st: NotStopd
t0: [00:00:00 03/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 33.3333 u1: ml/cmH st: NotStopd t0: [00:00:00 03/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 03/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [00:00:00 03/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 03/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [00:00:00 03/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [00:00:00 03/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [00:00:00 03/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 03/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 03/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 03/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [00:00:00 03/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [00:00:00 03/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 03/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 03/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [00:00:00 03/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.5 u1: L/min st: NotStopd t0: [00:00:00 03/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 03/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 03/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [00:00:00 03/05/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [00:00:00 03/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 6 u1: BPM st: NotStopd t0: [00:00:00 03/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 03/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [00:00:00 03/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 03/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 480 u1: ml/B st: NotStopd t0: [00:00:00 03/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [00:00:00 03/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 03/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 03/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [01:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [01:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 102 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [01:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [01:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [01:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [01:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [01:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [01:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml t0: [01:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [01:00:00 03/05/2011] 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: [01:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:10:00 02/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 19.6 rs: Final st: NotStopd
t0: [00:00:00 03/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White st: NotStopd t0: [00:00:00 03/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [02:00:00 03/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [02:00:00 03/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 03/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [02:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 03/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [02:00:00 03/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [02:00:00 03/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [02:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 88 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [02:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [02:00:00 03/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 03/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 03/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [02:00:00 03/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 03/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 03/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [02:00:00 03/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [02:00:00 03/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [02:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 03/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [03:00:00 03/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [03:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 03/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [03:00:00 03/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [03:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 03/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [03:00:00 03/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [03:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 03/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [03:00:00 03/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [03:00:00 03/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [03:00:00 03/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [03:00:00 03/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [03:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [03:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 03/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [03:00:00 03/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 03/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [03:00:00 03/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [03:00:00 03/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [03:00:00 03/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 03/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [03:00:00 03/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [03:00:00 03/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [03:00:00 03/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [03:00:00 03/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [03:00:00 03/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [03:00:00 03/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [03:00:00 03/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 03/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [03:00:00 03/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 03/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [03:00:00 03/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [03:00:00 03/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [03:00:00 03/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [03:00:00 03/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [03:00:00 03/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [03:00:00 03/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [03:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [03:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [03:00:00 03/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [03:00:00 03/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [03:00:00 03/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 03/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [03:00:00 03/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [03:00:00 03/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: CT scan st: NotStopd t0: [03:00:00 03/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [03:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [03:00:00 03/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [03:00:00 03/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [03:00:00 03/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [03:00:00 03/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [03:00:00 03/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [03:00:00 03/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [03:00:00 03/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: 3way Foley st: NotStopd t0: [03:00:00 03/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [03:00:00 03/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [03:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 03/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [03:00:00 03/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [03:00:00 03/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [03:00:00 03/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [03:00:00 03/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [03:00:00 03/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [03:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 100 vu: ml t0: [03:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [03:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 27.8208 vu: ml t0: [03:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 130 vu: ml t0: [03:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [02:00:00 03/05/2011] 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: [02:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:00:00 03/05/2011] 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: [03:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 03/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 90 cv: 90 ap: none t0: [23:00:00 03/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -7.5672 cv: -7.5672 ap: none t0: [23:00:00 03/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 22.4328 cv: 1356.82 ap: none t0: [23:00:00 03/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 82.4328 cv: 2756.82 ap: none t0: [23:00:00 03/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 1400 ap: none t0: [23:00:00 03/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 90 cv: 1665 ap: none t0: [23:00:00 03/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -7.5672 cv: 881.824 ap: none t0: [23:00:00 03/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 90 cv: 1875 ap: none t0: [23:00:00 03/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -7.5672 cv: 8090.36 ap: carryForward
t0: [04:40:00 03/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.38 rs: Final st: NotStopd t0: [04:40:00 03/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 2.3 rs: Final st: NotStopd t0: [04:40:00 03/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -4 rs: Final st: NotStopd t0: [04:40:00 03/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [04:40:00 03/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 32 u1: mmHg rs: Final st: NotStopd t0: [04:40:00 03/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.38 rs: Final st: NotStopd t0: [04:40:00 03/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.3 rs: Final st: NotStopd
t0: [04:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 03/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [04:00:00 03/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [04:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [04:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [04:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [04:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 03/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 03/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3889 u1: Deg. C st: NotStopd t0: [04:00:00 03/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.5 u1: Deg. F st: NotStopd t0: [04:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 03/05/2011] 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: [04:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [04:00:00 03/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 115.789 u1: units st: NotStopd t0: [04:00:00 03/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 115.789 u1: units st: NotStopd t0: [04:00:00 03/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [04:00:00 03/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.285 u1: L st: NotStopd t0: [04:40:00 03/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 33.3333 u1: ml/cmH st: NotStopd t0: [04:40:00 03/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [04:40:00 03/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [04:40:00 03/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:40:00 03/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [04:40:00 03/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [04:40:00 03/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [04:40:00 03/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:40:00 03/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [04:40:00 03/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:40:00 03/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [04:40:00 03/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [04:40:00 03/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:40:00 03/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:40:00 03/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:40:00 03/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.3 u1: L/min st: NotStopd t0: [04:40:00 03/05/2011] id: PAO2 el: 0 cu: MICU cg: RRT v1: 253.2 u1: mmHg st: NotStopd t0: [04:40:00 03/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:40:00 03/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:40:00 03/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [04:40:00 03/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [04:40:00 03/05/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [04:40:00 03/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [04:40:00 03/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [04:40:00 03/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [04:40:00 03/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:40:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:40:00 03/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 490 u1: ml/B st: NotStopd t0: [04:40:00 03/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [04:40:00 03/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:40:00 03/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:40:00 03/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd t0: [04:40:00 03/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: RRT v1: 457 u1: mmHg rs: Final st: NotStopd
t0: [05:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [05:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [05:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [05:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [05:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [05:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml t0: [05:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [05:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 27.8208 vu: ml t0: [05:00:00 03/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [05:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [05:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [05:00:00 03/05/2011] 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: [05:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [04:30:00 03/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.9 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 7.9 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 30.6 u1: % rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.9 u1: gm/dl rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 378 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.6 u1: /mic l rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.9 rs: Final st: NotStopd
t0: [06:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [06:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [06:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [06:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [06:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [06:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [06:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [06:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml t0: [06:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [06:00:00 03/05/2011] 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: [06:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [06:00:00 03/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 157 rs: Manual st: NotStopd
t0: [04:30:00 03/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 69 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 114 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 162 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 5.3 u1: mEq/L rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 69 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 114 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 162 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 5.3 u1: mEq/L rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd
t0: [07:00:00 03/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: -1 st: D/C'd
t0: [07:00:00 03/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [07:00:00 03/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [07:00:00 03/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [07:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 03/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [07:00:00 03/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [07:00:00 03/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [07:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 03/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [07:00:00 03/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [07:00:00 03/05/2011] id: IV #1 Reason DC'D el: 0 cu: MICU cg: RN st: NotStopd t0: [07:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 03/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [07:00:00 03/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [07:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 03/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [07:00:00 03/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 03/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [07:00:00 03/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [07:00:00 03/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [07:00:00 03/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [07:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [07:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 03/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [07:00:00 03/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 03/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [07:00:00 03/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [07:00:00 03/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [07:00:00 03/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 03/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [07:00:00 03/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [07:00:00 03/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [07:00:00 03/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [07:00:00 03/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [07:00:00 03/05/2011] id: IV #1 D/C Date el: 0 cu: MICU cg: RN v1: 3 v2: 16 st: NotStopd t0: [07:00:00 03/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 10 st: NotStopd t0: [07:00:00 03/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [07:00:00 03/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [07:00:00 03/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 03/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [07:00:00 03/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [07:00:00 03/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [07:00:00 03/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [07:00:00 03/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [07:00:00 03/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [07:00:00 03/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [07:00:00 03/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [07:00:00 03/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [07:00:00 03/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [07:00:00 03/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [07:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [07:00:00 03/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [07:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [07:00:00 03/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [07:00:00 03/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [07:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 03/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [07:00:00 03/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [07:00:00 03/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [07:00:00 03/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [07:00:00 03/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [07:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [07:00:00 03/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [07:00:00 03/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [07:00:00 03/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [07:00:00 03/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [07:00:00 03/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [07:00:00 03/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [07:00:00 03/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [07:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 03/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thin st: NotStopd t0: [07:00:00 03/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [07:00:00 03/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [07:00:00 03/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [07:00:00 03/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [07:00:00 03/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [07:00:00 03/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [07:00:00 03/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [07:00:00 03/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [07:00:00 03/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [07:00:00 03/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [07:00:00 03/05/2011] id: BSA - English el: 0 cu: MICU cg: RN v1: 0.41192 u1: m2 st: NotStopd t0: [07:00:00 03/05/2011] id: BSA - Metric el: 0 cu: MICU cg: RN v1: 0.481598 u1: m2 st: NotStopd t0: [07:00:00 03/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [07:00:00 03/05/2011] id: Weight Change el: 0 cu: MICU cg: RN v1: 11.5 u1: kg st: NotStopd t0: [07:00:00 03/05/2011] id: Daily Weight el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [07:00:00 03/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [07:00:00 03/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [07:00:00 03/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [07:00:00 03/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [07:00:00 03/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [07:00:00 03/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [07:00:00 03/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [07:00:00 03/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [07:00:00 03/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [07:00:00 03/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [07:00:00 03/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [07:00:00 03/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [07:00:00 03/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [07:00:00 03/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [07:00:00 03/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [07:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [07:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [07:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [07:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [07:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [07:00:00 03/05/2011] 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: [07:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 97 u1: BPM st: NotStopd t0: [08:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [08:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [08:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [08:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [08:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 03/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [08:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [08:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 55 vu: ml t0: [08:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [08:00:00 03/05/2011] 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: [08:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:00:00 03/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 33.3333 u1: ml/cmH st: NotStopd t0: [08:00:00 03/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 03/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [08:00:00 03/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 03/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:00:00 03/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:00:00 03/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [08:00:00 03/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 03/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 03/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 03/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:00:00 03/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [08:00:00 03/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 03/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 03/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:00:00 03/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.3 u1: L/min st: NotStopd t0: [08:00:00 03/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 03/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 03/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [08:00:00 03/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [08:00:00 03/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [08:00:00 03/05/2011] id: Plateau-Off el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [08:00:00 03/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [08:00:00 03/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [08:00:00 03/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:00:00 03/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 03/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 450 u1: ml/B st: NotStopd t0: [08:00:00 03/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [08:00:00 03/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 03/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 03/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 03/05/2011] id: ETT Position Change el: 0 cu: MICU cg: RRT v1: Done st: NotStopd
t0: [09:00:00 03/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 03/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 03/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 03/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 03/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 03/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN st: NotStopd t0: [09:00:00 03/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [09:00:00 03/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 03/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 03/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [09:00:00 03/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [09:00:00 03/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [09:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [09:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [09:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [09:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [09:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [09:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [09:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [09:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [09:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [09:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [09:00:00 03/05/2011] 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: [09:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [10:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [10:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [10:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [10:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [10:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [10:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [10:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [10:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [10:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [10:00:00 03/05/2011] 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: [10:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [10:00:00 03/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [10:00:00 03/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 03/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 03/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 03/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 03/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 03/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [10:00:00 03/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 03/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [10:00:00 03/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 03/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 03/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 03/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 03/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [10:00:00 03/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 03/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [10:00:00 03/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd
tf: [10:00:00 05/05/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Prednisone v1: 60 u1: mg
tf: [18:00:00 24/05/2011] pt: Unit Dose rt: IH fr: Q4H fs: 11, 15, 19, 23, 3, 7 dn: 6 m1: Albuterol-Ipratropium v1: 10 u1: PUFF
t0: [11:00:00 03/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [11:00:00 03/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [11:00:00 03/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 03/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [11:00:00 03/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [11:00:00 03/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [11:00:00 03/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [11:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 03/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [11:00:00 03/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 03/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [11:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 03/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [11:00:00 03/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [11:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 03/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [11:00:00 03/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [11:00:00 03/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 03/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [11:00:00 03/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [11:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [11:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 03/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [11:00:00 03/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [11:00:00 03/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 03/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [11:00:00 03/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [11:00:00 03/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [11:00:00 03/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 03/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [11:00:00 03/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [11:00:00 03/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [11:00:00 03/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [11:00:00 03/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 03/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 03/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 03/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 03/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [11:00:00 03/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [11:00:00 03/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [11:00:00 03/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [11:00:00 03/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [11:00:00 03/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [11:00:00 03/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [11:00:00 03/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [11:00:00 03/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [11:00:00 03/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [11:00:00 03/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [11:00:00 03/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [11:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [11:00:00 03/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 03/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 03/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [11:00:00 03/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [11:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [11:00:00 03/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [11:00:00 03/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [11:00:00 03/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [11:00:00 03/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 03/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [11:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [11:00:00 03/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [11:00:00 03/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [11:00:00 03/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [11:00:00 03/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 03/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [11:00:00 03/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [11:00:00 03/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [11:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [11:00:00 03/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Clear v2: Thin st: NotStopd t0: [11:00:00 03/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [11:00:00 03/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [11:00:00 03/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [11:00:00 03/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 03/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [11:00:00 03/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [11:00:00 03/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [11:00:00 03/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [11:00:00 03/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [11:00:00 03/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [11:00:00 03/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [11:00:00 03/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [11:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 03/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [11:00:00 03/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [11:00:00 03/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [11:00:00 03/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [11:00:00 03/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [11:00:00 03/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [11:00:00 03/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [11:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [11:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [11:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [11:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [11:00:00 03/05/2011] 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: [11:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 03/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 141 rs: Manual st: NotStopd
t0: [12:00:00 03/05/2011] id: Plateau-Off el: 0 cu: MICU cg: -1 st: D/C'd
t0: [12:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [12:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [12:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [12:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [12:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [12:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [12:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [12:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [12:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [12:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [12:00:00 03/05/2011] 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 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 10 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 03/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 03/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [12:00:00 03/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 03/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [12:00:00 03/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [12:00:00 03/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 03/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 03/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 03/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [12:00:00 03/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [12:00:00 03/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 03/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 03/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:00:00 03/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 15.4 u1: L/min st: NotStopd t0: [12:00:00 03/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 03/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 03/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 15 u1: . st: NotStopd t0: [12:00:00 03/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [12:00:00 03/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:00:00 03/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 525 u1: ml/B st: NotStopd t0: [12:00:00 03/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 03/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [12:45:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:45:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:45:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:45:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:45:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:45:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:45:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [12:45:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:45:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [12:45:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [12:45:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:45:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [12:45:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [12:45:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:45:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:45:00 03/05/2011] 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: [12:45:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [13:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [13:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [13:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [13:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [13:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [13:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [13:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [13:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [13:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4.347 vu: ml t0: [13:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [13:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [13:00:00 03/05/2011] 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: [13:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 03/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [13:00:00 03/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 27.7778 u1: ml/cmH st: NotStopd t0: [13:00:00 03/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [13:00:00 03/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [13:00:00 03/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [13:00:00 03/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [13:00:00 03/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [13:00:00 03/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [13:00:00 03/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [13:00:00 03/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 16.5 u1: L/min st: NotStopd t0: [13:00:00 03/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:00:00 03/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [13:00:00 03/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [13:00:00 03/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [13:00:00 03/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [13:00:00 03/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 9 u1: BPM st: NotStopd t0: [13:00:00 03/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [13:00:00 03/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [13:00:00 03/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [13:00:00 03/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [13:00:00 03/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [13:00:00 03/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd
t0: [04:30:00 03/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 6.6 u1: mg/dl rs: Final st: NotStopd t0: [04:30:00 03/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 6.6 u1: mg/dl rs: Final st: NotStopd
t0: [14:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [14:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [14:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [14:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [14:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [14:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [14:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [14:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [14:00:00 03/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [14:00:00 03/05/2011] tf: [14:07:00 24/05/2011] dt: 30247 id: Stool Out Stool el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [14:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [14:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [14:00:00 03/05/2011] 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 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 03/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 70 ap: none
t0: [14:45:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:45:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:45:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:45:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:45:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:45:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:45:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 103 u1: BPM st: NotStopd t0: [14:45:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:45:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [14:45:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [14:45:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:45:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [14:45:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [14:45:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:45:00 03/05/2011] 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: [14:45:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [14:45:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 92 u1: % st: NotStopd
t0: [15:26:00 03/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [15:26:00 03/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -5 rs: Final st: NotStopd t0: [15:26:00 03/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [15:26:00 03/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 34 u1: mmHg rs: Final st: NotStopd t0: [15:26:00 03/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 69 u1: mmHg rs: Final st: NotStopd t0: [15:26:00 03/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd
t0: [15:00:00 03/05/2011] id: Pain Present el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [15:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RRT v1: MICU st: NotStopd t0: [15:00:00 03/05/2011] id: CVP el: 0 cu: MICU cg: RRT v1: 9 u1: mmHg st: NotStopd t0: [15:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RRT v1: Full Code st: NotStopd t0: [15:00:00 03/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RRT v1: Sedated st: NotStopd t0: [15:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [15:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RRT v1: None st: NotStopd t0: [15:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RRT v1: None st: NotStopd t0: [15:00:00 03/05/2011] id: Alarms el: 0 cu: MICU cg: RRT v1: ON st: NotStopd t0: [15:00:00 03/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [15:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [15:00:00 03/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 1 u1: torr st: NotStopd t0: [15:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RRT v1: 101 u1: BPM st: NotStopd t0: [15:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RRT v1: Sinus Tachy st: NotStopd t0: [15:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RRT v1: 103 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [15:00:00 03/05/2011] id: Pain Location el: 0 cu: MICU cg: RRT v1: Not Indicated st: NotStopd t0: [15:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RRT v1: 65 u1: mmHg st: NotStopd t0: [15:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RRT v1: Universal st: NotStopd t0: [15:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RRT v1: 69.4 u1: kg st: NotStopd t0: [15:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [15:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 94 u1: % st: NotStopd t0: [15:00:00 03/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [15:00:00 03/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [15:00:00 03/05/2011] id: Temp. Site el: 0 cu: MICU cg: RRT v1: Oral st: NotStopd t0: [15:00:00 03/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RRT v1: 36.7778 u1: Deg. C st: NotStopd t0: [15:00:00 03/05/2011] id: Temperature F el: 0 cu: MICU cg: RRT v1: 98.2 u1: Deg. F st: NotStopd t0: [15:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RRT v1: 1 u1: kg st: NotStopd
t0: [15:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RRT ai: 107 vo: 60 vu: ml
t0: [15:00:00 03/05/2011] id: Midazolam el: 1 cu: MICU cg: RRT so: .9% Normal Saline vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RRT so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [15:10:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:10:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:10:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:10:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:10:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:10:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:10:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [15:10:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:10:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [15:10:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [15:10:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:10:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [15:10:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [15:10:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 88 u1: % st: NotStopd t0: [15:10:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:10:00 03/05/2011] 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: [15:10:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [13:00:00 03/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [13:00:00 03/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 03/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [13:00:00 03/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 03/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [13:00:00 03/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 03/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [13:00:00 03/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 03/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [13:00:00 03/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 03/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:00:00 03/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [13:00:00 03/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 03/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [13:00:00 03/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [13:00:00 03/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [13:00:00 03/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [13:00:00 03/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [13:00:00 03/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [15:00:00 03/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [15:00:00 03/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 03/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [15:00:00 03/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [15:00:00 03/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [15:00:00 03/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [15:00:00 03/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [15:00:00 03/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [15:00:00 03/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 03/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [15:00:00 03/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [15:00:00 03/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [15:00:00 03/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [15:00:00 03/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 03/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [15:00:00 03/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 03/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [15:00:00 03/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [15:00:00 03/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [15:00:00 03/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [15:00:00 03/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [15:00:00 03/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 03/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [15:00:00 03/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [15:00:00 03/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [15:00:00 03/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 03/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [15:00:00 03/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [15:00:00 03/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [15:00:00 03/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [15:00:00 03/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [15:00:00 03/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 03/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [15:00:00 03/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [15:00:00 03/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [15:00:00 03/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [15:00:00 03/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [15:00:00 03/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Soft st: NotStopd t0: [15:00:00 03/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [15:00:00 03/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [15:00:00 03/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [15:00:00 03/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [15:00:00 03/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [15:00:00 03/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [15:00:00 03/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 03/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [15:00:00 03/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [15:00:00 03/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [15:00:00 03/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [15:00:00 03/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [15:00:00 03/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [16:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [16:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 03/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 03/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 03/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 03/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 03/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [16:00:00 03/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 03/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 03/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 03/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 03/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 03/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 03/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 03/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [16:00:00 03/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [16:00:00 03/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 03/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [16:00:00 03/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [16:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [16:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [16:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [16:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [16:00:00 03/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [16:00:00 03/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 03/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [16:00:00 03/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 03/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 03/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 03/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 03/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 03/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 03/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [16:00:00 03/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd
t0: [15:00:00 03/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 35 vu: ml t0: [15:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [15:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5.2164 vu: ml t0: [15:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [15:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml t0: [16:00:00 03/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [16:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [16:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [16:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5.2164 vu: ml t0: [16:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [16:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [16:00:00 03/05/2011] 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 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:00:00 03/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 26.3158 u1: ml/cmH st: NotStopd t0: [16:00:00 03/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:00:00 03/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [16:00:00 03/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 1 u1: torr st: NotStopd t0: [16:00:00 03/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [16:00:00 03/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [16:00:00 03/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [16:00:00 03/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:00:00 03/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [16:00:00 03/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 03/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:00:00 03/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [16:00:00 03/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 10 v2: Albuterol st: NotStopd t0: [16:00:00 03/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 03/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [16:00:00 03/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 15.7 u1: L/min st: NotStopd t0: [16:00:00 03/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:00:00 03/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 03/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [16:00:00 03/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [16:00:00 03/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [16:00:00 03/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [16:00:00 03/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [16:00:00 03/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [16:00:00 03/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [16:00:00 03/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [16:00:00 03/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [16:00:00 03/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 572 u1: ml/B st: NotStopd t0: [16:00:00 03/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [16:00:00 03/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [16:00:00 03/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 03/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [16:31:00 03/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.39 rs: Final st: NotStopd t0: [16:31:00 03/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -4 rs: Final st: NotStopd t0: [16:31:00 03/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [16:31:00 03/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 32 u1: mmHg rs: Final st: NotStopd t0: [16:31:00 03/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 179 u1: mmHg rs: Final st: NotStopd t0: [16:31:00 03/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.39 rs: Final st: NotStopd
t0: [17:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [17:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [17:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [17:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [17:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [17:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 03/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [17:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [17:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5.2164 vu: ml t0: [17:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [17:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [17:00:00 03/05/2011] 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: [17:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [17:00:00 03/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd
t0: [16:00:00 03/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd
t0: [18:00:00 03/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 151 rs: Manual st: NotStopd
t0: [18:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [18:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [18:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [18:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [18:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [18:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [18:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5.2164 vu: ml t0: [18:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [18:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [18:00:00 03/05/2011] 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: [18:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [18:00:00 03/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 30 vu: ml
t0: [23:00:00 03/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 140 ap: none
t0: [18:00:00 03/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [18:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [18:00:00 03/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd
t0: [19:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [19:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [19:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [19:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [19:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [19:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [19:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [19:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [19:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5.2164 vu: ml t0: [19:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [19:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [19:00:00 03/05/2011] 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: [19:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:00:00 03/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 27.7778 u1: ml/cmH st: NotStopd t0: [20:00:00 03/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 03/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [20:00:00 03/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [20:00:00 03/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [20:00:00 03/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [20:00:00 03/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [20:00:00 03/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 03/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 03/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 03/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:00:00 03/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [20:00:00 03/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 03/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 03/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [20:00:00 03/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.2 u1: L/min st: NotStopd t0: [20:00:00 03/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 03/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 03/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [20:00:00 03/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [20:00:00 03/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [20:00:00 03/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [20:00:00 03/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [20:00:00 03/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [20:00:00 03/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 540 u1: ml/B st: NotStopd t0: [20:00:00 03/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [20:00:00 03/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 03/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 03/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 119 u1: BPM st: NotStopd t0: [20:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [20:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [20:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [20:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [20:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [20:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5.2164 vu: ml t0: [20:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [20:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [20:00:00 03/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:24:00 03/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd t0: [20:24:00 03/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 rs: Final st: NotStopd t0: [20:24:00 03/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -3 rs: Final st: NotStopd t0: [20:24:00 03/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [20:24:00 03/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 31 u1: mmHg rs: Final st: NotStopd t0: [20:24:00 03/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 104 u1: mmHg rs: Final st: NotStopd t0: [20:24:00 03/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd t0: [20:24:00 03/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 rs: Final st: NotStopd
t0: [21:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 123 u1: BPM st: NotStopd t0: [21:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [21:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [21:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [21:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [21:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [21:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [21:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [21:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 95 vu: ml t0: [21:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1.5 vu: ml
t0: [21:00:00 03/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:00:00 03/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 03/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 03/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 03/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [20:00:00 03/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd
t0: [21:00:00 03/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd
t0: [21:00:00 03/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 250 vu: ml
t0: [21:00:00 03/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: EKG st: NotStopd
t0: [20:00:00 03/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 03/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 03/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 03/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 03/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 03/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 03/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 03/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 03/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 03/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 03/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 03/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 03/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 03/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 03/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 03/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 03/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [20:00:00 03/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 03/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 03/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 03/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 03/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 03/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 03/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 03/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 03/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [20:00:00 03/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 03/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [20:00:00 03/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [20:00:00 03/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 03/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 03/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 03/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 03/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 03/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 03/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 03/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 03/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 03/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 03/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 03/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 03/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 03/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 03/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 03/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 03/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 03/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 03/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 03/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 03/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [20:00:00 03/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 03/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 03/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 03/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 03/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 03/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 03/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 03/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [20:00:00 03/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [20:00:00 03/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 03/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [20:00:00 03/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [21:00:00 03/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 03/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 03/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 03/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [21:00:00 03/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 03/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [21:00:00 03/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd
tf: [21:00:00 04/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 22 dn: 1 m1: Metoprolol v1: 5 u1: mg
t0: [22:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 114 u1: BPM st: NotStopd t0: [22:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [22:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [22:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [22:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [22:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [22:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [22:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [22:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 55 vu: ml t0: [22:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1.5 vu: ml
t0: [22:00:00 03/05/2011] 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 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:23:00 03/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 13 rs: Final st: NotStopd
t0: [23:00:00 03/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 03/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 03/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 03/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 03/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 03/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 03/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 114 u1: BPM st: NotStopd t0: [23:00:00 03/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 03/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [23:00:00 03/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [23:00:00 03/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 03/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [23:00:00 03/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [23:00:00 03/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 03/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 03/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [23:00:00 03/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 03/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [23:00:00 03/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 90 vu: ml t0: [23:00:00 03/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [23:00:00 03/05/2011] 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 03/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 04/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWork v1: 109 rs: Manual st: NotStopd
t0: [00:00:00 04/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 27.7778 u1: ml/cmH st: NotStopd t0: [00:00:00 04/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 04/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [00:00:00 04/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [00:00:00 04/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [00:00:00 04/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [00:00:00 04/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 04/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 04/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 04/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [00:00:00 04/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [00:00:00 04/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 04/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 04/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [00:00:00 04/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.8 u1: L/min st: NotStopd t0: [00:00:00 04/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 04/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 04/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [00:00:00 04/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [00:00:00 04/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 4 u1: BPM st: NotStopd t0: [00:00:00 04/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [00:00:00 04/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [00:00:00 04/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [00:00:00 04/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 533 u1: ml/B st: NotStopd t0: [00:00:00 04/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [00:00:00 04/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 04/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 04/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 114 u1: BPM st: NotStopd t0: [00:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [00:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [00:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [00:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [00:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [00:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [00:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [00:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [00:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [01:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 114 u1: BPM st: NotStopd t0: [01:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [01:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [01:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [01:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [01:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [01:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [01:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [01:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [01:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 04/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 04/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 04/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 04/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 04/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 04/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 04/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 04/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 04/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 04/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 04/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 04/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 04/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 04/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [00:00:00 04/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 04/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 04/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 04/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 04/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 04/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 04/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 04/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 04/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 04/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 04/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 04/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 04/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 04/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 04/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 04/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 04/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 04/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 04/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 04/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 04/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 04/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 04/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 04/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 04/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 04/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 04/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 04/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [00:00:00 04/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [00:00:00 04/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 04/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [00:00:00 04/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [01:00:00 04/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [01:00:00 04/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [01:00:00 04/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [01:00:00 04/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [01:00:00 04/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [01:00:00 04/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [01:00:00 04/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [01:00:00 04/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [01:00:00 04/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [01:00:00 04/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [01:00:00 04/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [01:00:00 04/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [01:00:00 04/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [01:00:00 04/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [01:00:00 04/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [01:00:00 04/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [02:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [02:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [02:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [02:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [02:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [02:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [02:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [02:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [02:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 04/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 04/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 04/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 04/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [00:00:00 04/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd
t0: [02:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 85 vu: ml
t0: [03:00:00 04/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd
t0: [03:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 110 u1: BPM st: NotStopd t0: [03:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [03:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [03:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [03:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [03:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [03:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [03:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [03:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [03:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml t0: [04:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [04:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [04:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [04:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [04:01:00 04/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.42 rs: Final st: NotStopd t0: [04:01:00 04/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -2 rs: Final st: NotStopd t0: [04:01:00 04/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [04:01:00 04/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 32 u1: mmHg rs: Final st: NotStopd t0: [04:01:00 04/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 81 u1: mmHg rs: Final st: NotStopd t0: [04:01:00 04/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.42 rs: Final st: NotStopd
t0: [04:01:00 04/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [04:01:00 04/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd
t0: [03:45:00 04/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.4 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 8.4 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 29.8 u1: % rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.8 u1: gm/dl rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 393 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.47 u1: /mic l rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.4 rs: Final st: NotStopd
t0: [05:00:00 04/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 29.4118 u1: ml/cmH st: NotStopd t0: [05:00:00 04/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 110 u1: units st: NotStopd t0: [05:00:00 04/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [05:00:00 04/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [05:00:00 04/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [05:00:00 04/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [05:00:00 04/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [05:00:00 04/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [05:00:00 04/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [05:00:00 04/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [05:00:00 04/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:00:00 04/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [05:00:00 04/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [05:00:00 04/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:00:00 04/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:00:00 04/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [05:00:00 04/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.2 u1: L/min st: NotStopd t0: [05:00:00 04/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [05:00:00 04/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 04/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [05:00:00 04/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [05:00:00 04/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 110 u1: units st: NotStopd t0: [05:00:00 04/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 4 u1: BPM st: NotStopd t0: [05:00:00 04/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [05:00:00 04/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [05:00:00 04/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [05:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [05:00:00 04/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [05:00:00 04/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.3 u1: L st: NotStopd t0: [05:00:00 04/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 502 u1: ml/B st: NotStopd t0: [05:00:00 04/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [05:00:00 04/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [05:00:00 04/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [05:00:00 04/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 04/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 04/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 111 u1: BPM st: NotStopd t0: [04:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [04:00:00 04/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [04:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [04:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [04:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [04:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [05:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [05:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [05:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [05:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [05:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [05:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [05:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [05:00:00 04/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vo: 450 vu: ml t0: [05:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [05:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [04:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [05:00:00 04/05/2011] 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: [05:00:00 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:45:00 04/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 71 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.1 u1: mg/dl rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 117 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4 u1: mEq/L rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 148 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 71 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.1 u1: mg/dl rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 117 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4 u1: mEq/L rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [03:45:00 04/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 148 rs: Final st: NotStopd
t0: [01:00:00 04/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 04/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [01:00:00 04/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 04/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 04/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 04/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 04/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 04/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 04/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 04/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 04/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 04/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 04/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 04/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 04/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 04/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 04/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 04/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 04/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 04/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 04/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 04/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [04:00:00 04/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 04/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 04/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 04/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 04/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 04/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 04/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 04/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 04/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [04:00:00 04/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: RN v1: Fingers st: NotStopd t0: [04:00:00 04/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 04/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 04/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 04/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 04/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 04/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 04/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 04/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 04/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 04/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 04/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 04/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 04/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 04/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 04/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 04/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 04/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 04/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 04/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 04/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 04/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 04/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 04/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 04/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [04:00:00 04/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 04/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 04/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 04/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 04/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 04/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 04/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 04/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [04:00:00 04/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [04:00:00 04/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 04/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [04:00:00 04/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [06:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [06:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [06:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [06:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [06:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [06:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [06:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [06:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [06:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [06:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [05:00:00 04/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [05:00:00 04/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 04/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [05:00:00 04/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [05:00:00 04/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [06:00:00 04/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 112 rs: Manual st: NotStopd t0: [07:00:00 04/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [07:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 04/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [07:00:00 04/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [07:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 04/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [07:00:00 04/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [07:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [07:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [07:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [07:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [07:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 04/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [07:00:00 04/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [07:00:00 04/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [07:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [07:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [07:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [07:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [07:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [07:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [07:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:00:00 04/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 04/05/2011] id: ImpSkin Character #3 el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 04/05/2011] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 04/05/2011] id: ImpSkin Treatment #3 el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 04/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 04/05/2011] id: Impaired Skin Site#3 el: 0 cu: MICU cg: -1 st: D/C'd
t0: [08:00:00 04/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 04/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 04/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 04/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 04/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 04/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 04/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 04/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 04/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 04/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 04/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 04/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 04/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [08:00:00 04/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 04/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 97 u1: BPM st: NotStopd t0: [08:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 04/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 04/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 04/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 04/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [08:00:00 04/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 04/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 04/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 04/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 04/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 04/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 04/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 04/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 04/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [08:00:00 04/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [08:00:00 04/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 04/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 04/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 04/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 04/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 04/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 04/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [08:00:00 04/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [08:00:00 04/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 04/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 04/05/2011] id: Previous Weight el: 0 cu: MICU cg: RN v1: 69.4 u1: kg st: NotStopd t0: [08:00:00 04/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 04/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 04/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 04/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 04/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [08:00:00 04/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 04/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 04/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [08:00:00 04/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 04/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 04/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 04/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [08:00:00 04/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Clear v2: Thin st: NotStopd t0: [08:00:00 04/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [08:00:00 04/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [08:00:00 04/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 04/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 04/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 04/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 04/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [08:00:00 04/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [08:00:00 04/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 04/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 04/05/2011] id: BSA - English el: 0 cu: MICU cg: RN v1: 0.413909 u1: m2 st: NotStopd t0: [08:00:00 04/05/2011] id: BSA - Metric el: 0 cu: MICU cg: RN v1: 0.483872 u1: m2 st: NotStopd t0: [08:00:00 04/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 04/05/2011] id: Weight Change el: 0 cu: MICU cg: RN v1: 0.6 u1: kg st: NotStopd t0: [08:00:00 04/05/2011] id: Daily Weight el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [08:00:00 04/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 04/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 04/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 04/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 04/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 04/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 04/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 04/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 04/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 04/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [08:00:00 04/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [08:00:00 04/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 04/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [08:00:00 04/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [08:00:00 04/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [08:00:00 04/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [08:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [08:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [08:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:00:00 04/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [08:00:00 04/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 04/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 04/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 04/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 04/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 04/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [08:00:00 04/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 04/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [08:00:00 04/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 04/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [08:00:00 04/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 26.3158 u1: ml/cmH st: NotStopd t0: [08:00:00 04/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 04/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [08:00:00 04/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [08:00:00 04/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:00:00 04/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:00:00 04/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [08:00:00 04/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 04/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 04/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 04/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:00:00 04/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [08:00:00 04/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 04/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 04/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [08:00:00 04/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 15.4 u1: L/min st: NotStopd t0: [08:00:00 04/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 04/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 04/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [08:00:00 04/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [08:00:00 04/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 6 u1: BPM st: NotStopd t0: [08:00:00 04/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 04/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:00:00 04/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:00:00 04/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 515 u1: ml/B st: NotStopd t0: [08:00:00 04/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [08:00:00 04/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 04/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 04/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [09:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [09:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [09:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [09:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [09:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [09:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [09:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [09:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [09:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml t0: [09:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [09:00:00 04/05/2011] 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: [09:00:00 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:00:00 04/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [09:00:00 04/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd
t0: [10:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [10:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [10:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [10:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [10:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [10:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 91 u1: % st: NotStopd t0: [10:00:00 04/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [10:00:00 04/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [10:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [10:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [10:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [10:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [10:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [11:00:00 04/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 10 v2: Albuterol st: NotStopd t0: [11:00:00 04/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [11:00:00 04/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd
t0: [11:00:00 04/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.8 u1: torr st: NotStopd
t0: [11:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 128 u1: BPM st: NotStopd t0: [11:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [11:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [11:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [11:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [11:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 92 u1: % st: NotStopd t0: [11:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [11:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [11:00:00 04/05/2011] tf: [13:00:00 06/05/2011] dt: 3000 id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [11:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [11:00:00 04/05/2011] 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: [11:00:00 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 04/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 29.4118 u1: ml/cmH st: NotStopd t0: [12:00:00 04/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 04/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [12:00:00 04/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [12:00:00 04/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [12:00:00 04/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [12:00:00 04/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [12:00:00 04/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 04/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 04/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 04/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [12:00:00 04/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [12:00:00 04/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 04/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 04/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [12:00:00 04/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.6 u1: L/min st: NotStopd t0: [12:00:00 04/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:00:00 04/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 04/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [12:00:00 04/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [12:00:00 04/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [12:00:00 04/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 4 u1: BPM st: NotStopd t0: [12:00:00 04/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [12:00:00 04/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [12:00:00 04/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [12:00:00 04/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 470 u1: ml/B st: NotStopd t0: [12:00:00 04/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [12:00:00 04/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:00:00 04/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 04/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 04/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [10:00:00 04/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [10:00:00 04/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 04/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 04/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 04/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 04/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 04/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 04/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 04/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [10:00:00 04/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 04/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [11:00:00 04/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 04/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 04/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [11:00:00 04/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [11:00:00 04/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 04/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [11:00:00 04/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [12:00:00 04/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 04/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 04/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 04/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 04/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 04/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 04/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [12:00:00 04/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 04/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 04/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 04/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 04/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [12:00:00 04/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [12:00:00 04/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 04/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [12:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 04/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [12:00:00 04/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 04/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 04/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [12:00:00 04/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 04/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 04/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 04/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [12:00:00 04/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 04/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [12:00:00 04/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [12:00:00 04/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 04/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 04/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 04/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 04/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [12:00:00 04/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [12:00:00 04/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [12:00:00 04/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [12:00:00 04/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 04/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [12:00:00 04/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 04/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 04/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 04/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 04/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [12:00:00 04/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 04/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 04/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [12:00:00 04/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 04/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [12:00:00 04/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 04/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [12:00:00 04/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [12:00:00 04/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 04/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 04/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 04/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [12:00:00 04/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [12:00:00 04/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [12:00:00 04/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 04/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 04/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 04/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 146 rs: Manual st: NotStopd t0: [12:00:00 04/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 04/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [12:00:00 04/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [12:00:00 04/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 04/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [12:00:00 04/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [12:00:00 04/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [12:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [12:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [12:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 180 vu: ml t0: [12:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [12:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [13:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [13:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 96 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [13:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [13:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [13:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [13:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [13:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [13:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [13:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [13:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [13:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [13:00:00 04/05/2011] 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: [13:00:00 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [14:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [14:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [14:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [14:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [14:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [14:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [14:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [14:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [14:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 110 vu: ml t0: [14:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [14:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [15:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [15:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [15:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [15:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [15:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [15:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [15:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [15:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [15:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [15:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [15:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [15:32:00 04/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd t0: [15:32:00 04/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -3 rs: Final st: NotStopd t0: [15:32:00 04/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [15:32:00 04/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 31 u1: mmHg rs: Final st: NotStopd t0: [15:32:00 04/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 89 u1: mmHg rs: Final st: NotStopd t0: [15:32:00 04/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd
t0: [16:00:00 04/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 25 u1: ml/cmH st: NotStopd t0: [16:00:00 04/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:00:00 04/05/2011] id: ETT Position Change el: 0 cu: MICU cg: RRT v1: Done st: NotStopd t0: [16:00:00 04/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [16:00:00 04/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [16:00:00 04/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [16:00:00 04/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [16:00:00 04/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [16:00:00 04/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:00:00 04/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [16:00:00 04/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 04/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:00:00 04/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [16:00:00 04/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 04/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 04/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [16:00:00 04/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.5 u1: L/min st: NotStopd t0: [16:00:00 04/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:00:00 04/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 04/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [16:00:00 04/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [16:00:00 04/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [16:00:00 04/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [16:00:00 04/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [16:00:00 04/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [16:00:00 04/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [16:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [16:00:00 04/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [16:00:00 04/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [16:00:00 04/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [16:00:00 04/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [16:00:00 04/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [16:00:00 04/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 04/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [16:00:00 04/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 04/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 04/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 04/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [16:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [16:00:00 04/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [16:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [16:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [16:00:00 04/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 04/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [16:00:00 04/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [16:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 04/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [16:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [16:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [16:00:00 04/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [16:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [16:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [16:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [14:00:00 04/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [14:00:00 04/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 04/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 04/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 04/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 04/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 04/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 04/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 04/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [14:00:00 04/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [15:00:00 04/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [15:00:00 04/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 04/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 04/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 04/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [15:00:00 04/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 04/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 04/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [15:00:00 04/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [15:00:00 04/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [15:00:00 04/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [15:00:00 04/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 04/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 04/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 04/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 04/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 04/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 04/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 04/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 04/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 04/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [16:00:00 04/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 04/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 04/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 04/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 04/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 04/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 04/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [16:00:00 04/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 04/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 04/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 04/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 04/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 04/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 04/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 04/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 04/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [16:00:00 04/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [16:00:00 04/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 04/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 04/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 04/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 04/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [16:00:00 04/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [16:00:00 04/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 04/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 04/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 04/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 04/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 04/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 04/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 04/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 04/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 04/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 04/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [16:00:00 04/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 04/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [16:00:00 04/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 04/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 04/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [16:00:00 04/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 04/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 04/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [16:00:00 04/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 04/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 04/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 04/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 04/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 04/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 04/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 04/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 04/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 04/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [16:00:00 04/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 04/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [16:00:00 04/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [16:00:00 04/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 04/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [16:00:00 04/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [15:00:00 04/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [16:00:00 04/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
tf: [09:00:00 08/05/2011] pt: IV Piggyback rt: IV fr: Q12H fs: 6, 18 dn: 2 m1: Vancomycin HCl v1: 1000 u1: mg m2: Iso-Osmotic Dextrose v2: 200 u2: ml
t0: [17:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [17:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [17:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [17:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [17:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [17:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [17:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [17:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [17:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [17:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [17:00:00 04/05/2011] 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: [17:00:00 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [17:00:00 04/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 154 rs: Manual st: NotStopd
t0: [17:00:00 04/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [18:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [18:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [18:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [18:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [18:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [18:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [18:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [18:00:00 04/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 110 vu: ml t0: [18:00:00 04/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [18:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [18:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [18:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 04/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 510 ap: none t0: [23:00:00 04/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 230 ap: none
t0: [18:00:00 04/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [18:00:00 04/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 04/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 04/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 04/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 04/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 04/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 04/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [18:00:00 04/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 04/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 04/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 04/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 04/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 04/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 04/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [18:00:00 04/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 04/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [18:00:00 04/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd
t0: [19:00:00 04/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [19:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 04/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [19:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [19:00:00 04/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [19:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [19:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [19:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [19:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [19:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [19:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [19:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [19:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [19:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [20:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [20:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [20:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [20:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd
t0: [19:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [20:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [20:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [20:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [20:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [20:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [17:40:00 04/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 66 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 116 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 167 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 144 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 66 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 116 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 167 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [17:40:00 04/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 144 rs: Final st: NotStopd
id: Insulin el: 100 cu: MICU cg: RN io: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions am: 100 du: Uhr rt: IV Drip
id: .9% Normal Saline el: 1 cu: MICU cg: RN io: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions vo: 100 du: ml rt: Intravenous Push
t0: [20:06:00 04/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 26.3158 u1: ml/cmH st: NotStopd t0: [20:06:00 04/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:06:00 04/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [20:06:00 04/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [20:06:00 04/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [20:06:00 04/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [20:06:00 04/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [20:06:00 04/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:06:00 04/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [20:06:00 04/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.6 u1: Deg. C st: NotStopd t0: [20:06:00 04/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:06:00 04/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [20:06:00 04/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:06:00 04/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:06:00 04/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [20:06:00 04/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [20:06:00 04/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:06:00 04/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:06:00 04/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [20:06:00 04/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [20:06:00 04/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [20:06:00 04/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [20:06:00 04/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [20:06:00 04/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [20:06:00 04/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:06:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:06:00 04/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:06:00 04/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [20:06:00 04/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 496 u1: ml/B st: NotStopd t0: [20:06:00 04/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [20:06:00 04/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:06:00 04/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:06:00 04/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
tf: [21:00:00 04/05/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Humulin-R Insulin v1: 100 u1: UNIT m2: NS v2: 100 u2: ml
t0: [20:00:00 04/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 04/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 04/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 04/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 04/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 04/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 04/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 04/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [20:00:00 04/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 04/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 04/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 04/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [20:00:00 04/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 04/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 04/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 04/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [20:00:00 04/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 04/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 04/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 04/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 04/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 04/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 04/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 04/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 04/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 04/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [20:00:00 04/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 04/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 04/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 04/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 04/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 04/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 04/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 04/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 04/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [20:00:00 04/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 04/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [20:00:00 04/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 04/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 04/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 04/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 04/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 04/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 04/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 04/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [20:00:00 04/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 04/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 04/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 04/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 04/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [20:00:00 04/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 04/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 04/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [20:00:00 04/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [20:00:00 04/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [20:00:00 04/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [20:00:00 04/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 04/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [20:00:00 04/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 04/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 04/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 04/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 04/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [20:00:00 04/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [20:00:00 04/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 04/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [20:00:00 04/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [21:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [21:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [21:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [21:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 04/05/2011] id: Previous Weight el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [21:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [21:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [21:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [21:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 04/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 115 rs: Manual st: NotStopd
t0: [21:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [21:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [21:00:00 04/05/2011] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 107 vu: ml nb: 1 t0: [21:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [21:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [21:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [19:00:00 04/05/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 12.5 u1: mg tf: [10:00:00 05/05/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 25 u1: mg tf: [18:00:00 24/05/2011] pt: Unit Dose rt: SC fr: ASDIR m1: Insulin v1: 0 u1: UNIT
t0: [22:00:00 04/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 104 rs: Manual st: NotStopd
t0: [22:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [22:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [22:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [22:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [22:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [22:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [22:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [22:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [22:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [22:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [22:00:00 04/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [22:00:00 04/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 04/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [23:00:00 04/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 04/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 04/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 04/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 04/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 04/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 04/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [23:00:00 04/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 04/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [23:00:00 04/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [23:00:00 04/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 04/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [23:00:00 04/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [23:00:00 04/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 04/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [23:00:00 04/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [23:00:00 04/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 04/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [23:00:00 04/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [23:00:00 04/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [21:00:00 04/05/2011] tf: [14:07:00 24/05/2011] dt: 28387 id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: Uhr sv: 100 su: ml rt: IV Drip t0: [22:00:00 04/05/2011] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: Uhr sv: 100 su: ml rt: IV Drip t0: [23:00:00 04/05/2011] 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 04/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 04/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 50 cv: 50 ap: none t0: [23:00:00 04/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 18.9552 cv: 886.223 ap: none t0: [23:00:00 04/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 1440 ap: none t0: [23:00:00 04/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 50 cv: 1735 ap: none t0: [23:00:00 04/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 50 cv: 2475 ap: none
t0: [00:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 05/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 05/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 05/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 05/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [00:00:00 05/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 05/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [00:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 05/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [00:00:00 05/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 05/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [00:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [00:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [00:00:00 05/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [00:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [00:00:00 05/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 05/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5556 u1: Deg. C st: NotStopd t0: [00:00:00 05/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.6 u1: Deg. F st: NotStopd t0: [00:00:00 05/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 05/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 05/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [00:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [00:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [00:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 65 vu: ml t0: [00:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [00:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 04/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 94 rs: Manual st: NotStopd t0: [00:00:00 05/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 105 rs: Manual st: NotStopd
t0: [00:00:00 05/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 05/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [00:47:00 05/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 25 u1: ml/cmH st: NotStopd t0: [00:47:00 05/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:47:00 05/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [00:47:00 05/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [00:47:00 05/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [00:47:00 05/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [00:47:00 05/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [00:47:00 05/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:47:00 05/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [00:47:00 05/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [00:47:00 05/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [00:47:00 05/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [00:47:00 05/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:47:00 05/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:47:00 05/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [00:47:00 05/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 15.9 u1: L/min st: NotStopd t0: [00:47:00 05/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:47:00 05/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:47:00 05/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [00:47:00 05/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [00:47:00 05/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 9 u1: BPM st: NotStopd t0: [00:47:00 05/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [00:47:00 05/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [00:47:00 05/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [00:47:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [00:47:00 05/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 563 u1: ml/B st: NotStopd t0: [00:47:00 05/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [00:47:00 05/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:47:00 05/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:47:00 05/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [01:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [01:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [01:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [01:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [01:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [01:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 04/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [00:00:00 05/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [00:00:00 05/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [01:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [01:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [01:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [01:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [01:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 04/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 28.9552 cv: 28.9552 ap: none t0: [23:00:00 04/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 78.9552 cv: 3076.22 ap: none t0: [23:00:00 04/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 28.9552 cv: 601.223 ap: none t0: [23:00:00 04/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 28.9552 cv: 8691.58 ap: carryForward
t0: [02:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [02:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [02:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [02:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [02:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [02:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [02:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [02:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [02:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [02:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [02:00:00 05/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [02:00:00 05/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 05/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [03:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [03:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [03:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [03:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [03:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [03:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [03:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 05/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vu: ml t0: [03:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [03:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [03:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [03:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [03:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 05/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 140 cv: 140 ap: none t0: [23:00:00 05/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -59.306 cv: -59.306 ap: none t0: [23:00:00 05/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 20.694 cv: 1257.51 ap: none t0: [23:00:00 05/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 80.694 cv: 4227.51 ap: none t0: [23:00:00 05/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 1440 ap: none t0: [23:00:00 05/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 140 cv: 1645 ap: none t0: [23:00:00 05/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -59.306 cv: 2042.51 ap: none t0: [23:00:00 05/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 140 cv: 2185 ap: none t0: [23:00:00 05/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -59.306 cv: 10734.1 ap: carryForward
t0: [00:00:00 05/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 05/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 05/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 05/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 05/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 05/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 05/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 05/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 05/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [00:00:00 05/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 05/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 05/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 05/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 05/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 05/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 05/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 05/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 05/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 05/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 05/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 05/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 05/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 05/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 05/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 05/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 05/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 05/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 05/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 05/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 05/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 05/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [00:00:00 05/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 05/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 05/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 05/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 05/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 05/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 05/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 05/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [00:00:00 05/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 05/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 05/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [00:00:00 05/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [00:00:00 05/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 05/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd
t0: [04:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 05/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 05/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 05/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 05/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 05/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [04:00:00 05/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 05/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [04:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 05/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 05/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 05/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 05/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [04:00:00 05/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [04:00:00 05/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 05/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [04:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [04:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [04:00:00 05/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 05/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 05/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [04:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [04:00:00 05/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 05/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 05/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 05/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 05/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sludge st: NotStopd t0: [04:00:00 05/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 05/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 05/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 05/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [04:00:00 05/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [04:00:00 05/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 05/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [04:00:00 05/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [04:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [04:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [04:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [04:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 75 vu: ml t0: [04:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [04:00:00 05/05/2011] 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 05/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 05/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [04:00:00 05/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd
tf: [03:00:00 06/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 4 dn: 1 m1: Fluconazole v1: 150 u1: mg
t0: [03:58:00 05/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.3 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 8.3 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 32 u1: % rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.5 u1: gm/dl rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 404 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.77 u1: /mic l rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.3 rs: Final st: NotStopd
t0: [05:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 103 u1: BPM st: NotStopd t0: [05:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [05:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [05:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [05:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [05:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [05:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [05:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [05:00:00 05/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [05:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [05:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [05:00:00 05/05/2011] 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: [03:58:00 05/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 62 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 115 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 u1: mEq/L rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 62 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 115 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 u1: mEq/L rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd
t0: [03:58:00 05/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [03:58:00 05/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd
t0: [05:00:00 05/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 29.4118 u1: ml/cmH st: NotStopd t0: [05:00:00 05/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 173.077 u1: units st: NotStopd t0: [05:00:00 05/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [05:00:00 05/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [05:00:00 05/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [05:00:00 05/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [05:00:00 05/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [05:00:00 05/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [05:00:00 05/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [05:00:00 05/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [05:00:00 05/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [05:00:00 05/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [05:00:00 05/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [05:00:00 05/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:00:00 05/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:00:00 05/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [05:00:00 05/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.7 u1: L/min st: NotStopd t0: [05:00:00 05/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [05:00:00 05/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 05/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [05:00:00 05/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [05:00:00 05/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [05:00:00 05/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 173.077 u1: units st: NotStopd t0: [05:00:00 05/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [05:00:00 05/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [05:00:00 05/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [05:00:00 05/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [05:00:00 05/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [05:00:00 05/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.26 u1: L st: NotStopd t0: [05:00:00 05/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 508 u1: ml/B st: NotStopd t0: [05:00:00 05/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [05:00:00 05/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [05:00:00 05/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [05:00:00 05/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 05/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 05/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 05/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 05/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 05/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 05/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [00:00:00 05/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 05/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 05/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 05/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 05/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 05/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 05/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 05/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [04:00:00 05/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 05/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 05/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 05/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 05/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 05/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 05/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 05/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 05/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 05/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 05/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 05/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 05/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 05/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [04:00:00 05/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 05/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 05/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 05/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [04:00:00 05/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 05/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 05/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [06:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 05/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [06:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [06:00:00 05/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [06:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [06:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [06:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [06:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [06:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [06:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml t0: [06:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [06:00:00 05/05/2011] 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 05/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [06:00:00 05/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.7778 u1: Deg. C st: NotStopd t0: [06:00:00 05/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100 u1: Deg. F st: NotStopd
t0: [06:00:00 05/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 200 vu: ml t0: [06:00:00 05/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vo: 150 vu: ml
t0: [23:00:00 05/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 150 ap: none
t0: [06:00:00 05/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 90 rs: Manual st: NotStopd
t0: [06:00:00 05/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [04:00:00 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [05:00:00 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [06:00:00 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:58:00 05/05/2011] id: Vancomycin/Trough Drug Level el: 0 cu: MICU cg: 1663 v1: 16.2 rs: Final st: NotStopd
t0: [07:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 101 u1: BPM st: NotStopd t0: [07:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [07:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [07:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [07:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [07:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 05/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 05/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 05/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 05/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 05/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 05/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 05/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 05/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 05/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [08:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 05/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 2 To pain st: NotStopd t0: [08:00:00 05/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [08:00:00 05/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 05/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [08:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 05/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 05/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 05/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 05/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 05/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [08:00:00 05/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 05/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 05/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 05/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 05/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 05/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 05/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Hematoma st: NotStopd t0: [08:00:00 05/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 05/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Purple st: NotStopd t0: [08:00:00 05/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 05/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 05/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [08:00:00 05/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 05/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 05/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 05/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [08:00:00 05/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [08:00:00 05/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [08:00:00 05/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 05/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [08:00:00 05/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 05/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 05/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [08:00:00 05/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 05/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 05/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [08:00:00 05/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 05/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [08:00:00 05/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [08:00:00 05/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [08:00:00 05/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 05/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 05/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 05/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38 u1: Deg. C st: NotStopd t0: [08:00:00 05/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.4 u1: Deg. F st: NotStopd t0: [08:00:00 05/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:00:00 05/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 05/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 05/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 05/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 05/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 05/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 05/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 05/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 05/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 05/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 05/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 05/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [08:00:00 05/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [08:00:00 05/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 05/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [08:00:00 05/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [07:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [07:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [07:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [07:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [08:00:00 05/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [08:00:00 05/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [08:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [08:00:00 05/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [08:00:00 05/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [08:00:00 05/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 30 vu: ml t0: [08:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [08:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [07:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [08:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 05/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 30 ap: none
t0: [08:00:00 05/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 22.7273 u1: ml/cmH st: NotStopd t0: [08:00:00 05/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 05/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [08:00:00 05/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [08:00:00 05/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:00:00 05/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:00:00 05/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [08:00:00 05/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 05/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 05/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 05/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:00:00 05/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [08:00:00 05/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 05/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 05/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [08:00:00 05/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 19 u1: L/min st: NotStopd t0: [08:00:00 05/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 05/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 05/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [08:00:00 05/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [08:00:00 05/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [08:00:00 05/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [08:00:00 05/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [08:00:00 05/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:00:00 05/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 05/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 05/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 540 u1: ml/B st: NotStopd t0: [08:00:00 05/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [08:00:00 05/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 05/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 05/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:50:00 05/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.44 rs: Final st: NotStopd t0: [08:50:00 05/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [08:50:00 05/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -3 rs: Final st: NotStopd t0: [08:50:00 05/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [08:50:00 05/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 27 u1: mmHg rs: Final st: NotStopd t0: [08:50:00 05/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 71 u1: mmHg rs: Final st: NotStopd t0: [08:50:00 05/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.44 rs: Final st: NotStopd t0: [08:50:00 05/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd
t0: [09:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 05/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.7 u1: torr st: NotStopd t0: [09:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 119 u1: BPM st: NotStopd t0: [09:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [09:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [09:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [09:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [09:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 91 u1: % st: NotStopd t0: [09:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 05/05/2011] 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: [09:00:00 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:00:00 05/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 05/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 05/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 05/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 05/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [09:00:00 05/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 05/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd t0: [09:00:00 05/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [09:00:00 05/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd
t0: [09:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [09:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [09:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [09:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [10:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 05/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 05/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 120 u1: BPM st: NotStopd t0: [10:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 05/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 05/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 05/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [10:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [10:00:00 05/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [10:00:00 05/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [10:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [10:00:00 05/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [10:00:00 05/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [10:00:00 05/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [10:00:00 05/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [10:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [10:00:00 05/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 110 vu: ml t0: [10:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [10:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [10:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [11:00:00 07/05/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Prednisone v1: 40 u1: mg
t0: [08:00:00 05/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 05/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 05/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [11:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 110 u1: BPM st: NotStopd t0: [11:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 05/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 05/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 05/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 05/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [11:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [11:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [11:00:00 05/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 05/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [11:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [11:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [11:00:00 05/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [11:00:00 05/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [11:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 05/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vu: ml t0: [10:00:00 05/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vu: ml t0: [11:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [11:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [11:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [11:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [11:00:00 05/05/2011] 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: [11:00:00 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [10:00:00 06/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Calcium Gluconate v1: 2 u1: gm tf: [10:00:00 06/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm tf: [19:00:00 19/05/2011] pt: Unit Dose rt: IV fr: Q2H:PRN m1: Fentanyl Citrate v1: 25-100 u1: mcg
t0: [11:30:00 05/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: RN v1: 140 rs: Manual st: NotStopd
t0: [10:00:00 05/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [10:00:00 05/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 05/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 05/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [10:00:00 05/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 05/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 05/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 05/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 05/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 05/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [10:00:00 05/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 05/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 05/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [11:00:00 05/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [11:00:00 05/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 05/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [11:00:00 05/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [11:00:00 05/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [11:00:00 05/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 05/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [12:00:00 05/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 05/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 05/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 05/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 05/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 05/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 05/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [12:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 05/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 05/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 05/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 05/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [12:00:00 05/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 05/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [12:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 05/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [12:00:00 05/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 05/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 05/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [12:00:00 05/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 05/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 05/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 05/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 05/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Hematoma st: NotStopd t0: [12:00:00 05/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 05/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 05/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 05/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 05/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 05/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [12:00:00 05/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 84 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [12:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [12:00:00 05/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [12:00:00 05/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 05/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 05/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 05/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 05/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [12:00:00 05/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 05/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 05/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 05/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 05/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [12:00:00 05/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [12:00:00 05/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 05/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 05/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 05/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [12:00:00 05/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [12:00:00 05/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Cloudy st: NotStopd t0: [12:00:00 05/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 05/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 05/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 05/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [12:00:00 05/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [12:00:00 05/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 05/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [12:00:00 05/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [12:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [11:00:00 05/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 05/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [11:00:00 05/05/2011] id: PainLevel Acceptable el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 05/05/2011] id: Pain Cause el: 0 cu: MICU cg: RN v1: At Rest st: NotStopd t0: [11:00:00 05/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 05/05/2011] id: Pain Management el: 1 cu: MICU cg: RN v1: IV Push st: NotStopd t0: [11:00:00 05/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 05/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [12:00:00 05/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [13:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 05/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [13:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 05/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [13:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 05/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [13:00:00 05/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [13:00:00 05/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [13:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [13:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [13:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [13:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [13:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [13:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [13:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 05/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [12:00:00 05/05/2011] tf: [08:00:00 17/05/2011] dt: 17040 id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [12:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [12:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [12:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [13:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [13:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [13:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [13:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [13:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [13:00:00 05/05/2011] 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: [13:00:00 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 05/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 29.4118 u1: ml/cmH st: NotStopd t0: [12:00:00 05/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 05/05/2011] id: ETT Position Change el: 0 cu: MICU cg: RRT v1: Done st: NotStopd t0: [12:00:00 05/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [12:00:00 05/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.7 u1: torr st: NotStopd t0: [12:00:00 05/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [12:00:00 05/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [12:00:00 05/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2,1 st: NotStopd t0: [12:00:00 05/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 05/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 05/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [12:00:00 05/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [12:00:00 05/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 05/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 05/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [12:00:00 05/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.5 u1: L/min st: NotStopd t0: [12:00:00 05/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:00:00 05/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 05/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [12:00:00 05/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [12:00:00 05/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [12:00:00 05/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [12:00:00 05/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [12:00:00 05/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [12:00:00 05/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:00:00 05/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 530 u1: ml/B st: NotStopd t0: [12:00:00 05/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [12:00:00 05/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:00:00 05/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 05/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [13:00:00 05/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd t0: [14:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 05/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [14:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 05/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [14:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 05/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 05/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [14:00:00 05/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [14:00:00 05/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Hematoma st: NotStopd t0: [14:00:00 05/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [14:00:00 05/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 05/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 05/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Purple st: NotStopd t0: [14:00:00 05/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [14:00:00 05/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [14:00:00 05/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [14:00:00 05/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [14:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [14:00:00 05/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [14:00:00 05/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [14:00:00 05/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [14:00:00 05/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 05/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 05/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 05/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 05/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 05/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [14:00:00 05/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 05/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 05/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [14:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [14:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 05/05/2011] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [14:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [14:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [14:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [15:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [15:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 95 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [15:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [15:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [15:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [15:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [15:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [15:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [15:00:00 05/05/2011] tf: [12:15:00 10/05/2011] dt: 7035 id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [15:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [15:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [14:00:00 05/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [14:00:00 05/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 05/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 05/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 05/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 05/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd
t0: [12:00:00 05/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN st: NotStopd t0: [16:00:00 05/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 05/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 05/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 05/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [16:00:00 05/05/2011] id: PainLevel Acceptable el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 05/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 05/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 05/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 05/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 05/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 05/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 05/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [16:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 05/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 05/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [16:00:00 05/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [16:00:00 05/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 05/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 05/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 05/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 05/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 05/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [16:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 05/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 05/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 05/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 05/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 05/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [16:00:00 05/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 05/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 05/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 05/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 05/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 05/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 05/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 05/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 05/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 05/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 05/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [16:00:00 05/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 102 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [16:00:00 05/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [16:00:00 05/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [16:00:00 05/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 05/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [16:00:00 05/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 05/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 05/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [16:00:00 05/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 05/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 05/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [16:00:00 05/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [16:00:00 05/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thin st: NotStopd t0: [16:00:00 05/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [16:00:00 05/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [16:00:00 05/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 05/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 05/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 05/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.1667 u1: Deg. C st: NotStopd t0: [16:00:00 05/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.1 u1: Deg. F st: NotStopd t0: [16:00:00 05/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 05/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 05/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 05/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 05/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 05/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [16:00:00 05/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 05/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 05/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [16:00:00 05/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [16:00:00 05/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 05/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [16:00:00 05/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [16:00:00 05/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 05/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 05/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [16:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [16:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [16:00:00 05/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [16:00:00 05/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [16:00:00 05/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [16:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [16:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [16:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 05/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 390 ap: none
t0: [12:00:00 05/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 05/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 27.7778 u1: ml/cmH st: NotStopd t0: [16:00:00 05/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:00:00 05/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [16:00:00 05/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [16:00:00 05/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [16:00:00 05/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [16:00:00 05/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [16:00:00 05/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:00:00 05/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [16:00:00 05/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 05/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:00:00 05/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [16:00:00 05/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 05/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 05/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [16:00:00 05/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.8 u1: L/min st: NotStopd t0: [16:00:00 05/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:00:00 05/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 05/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [16:00:00 05/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [16:00:00 05/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [16:00:00 05/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [16:00:00 05/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [16:00:00 05/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [16:00:00 05/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:00:00 05/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 480 u1: ml/B st: NotStopd t0: [16:00:00 05/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [16:00:00 05/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [16:00:00 05/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 05/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [17:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 05/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [17:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [17:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 05/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 05/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [17:00:00 05/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [17:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [17:00:00 05/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [17:00:00 05/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [17:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [17:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [17:00:00 05/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [17:00:00 05/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [17:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [17:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:00:00 05/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [17:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [17:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [17:00:00 05/05/2011] 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: [17:00:00 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [17:49:00 05/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.42 rs: Final st: NotStopd t0: [17:49:00 05/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [17:49:00 05/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -2 rs: Final st: NotStopd t0: [17:49:00 05/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [17:49:00 05/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 31 u1: mmHg rs: Final st: NotStopd t0: [17:49:00 05/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 109 u1: mmHg rs: Final st: NotStopd t0: [17:49:00 05/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.42 rs: Final st: NotStopd t0: [17:49:00 05/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd
tf: [19:00:00 19/05/2011] pt: IV Piggyback rt: IV fr: Q24H fs: 14 dn: 1 m1: Levofloxacin v1: 500 u1: mg m2: Dextrose 5% v2: 100 u2: ml
t0: [17:00:00 05/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Sputum Cx st: NotStopd t0: [17:00:00 05/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [18:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [18:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [18:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [18:00:00 05/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Blood Cultured st: NotStopd t0: [18:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [18:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [18:00:00 05/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [18:00:00 05/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [18:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 05/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [18:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [18:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 05/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [18:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [18:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [18:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [18:00:00 05/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: RN v1: 215 rs: Manual st: NotStopd
id: Propofol el: 101 cu: MICU cg: RN io: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions am: 1000 du: mcgkgmin rt: IV Drip
id: N/A el: 1 cu: MICU cg: RN io: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions vo: 100 du: vl rt: Intravenous Push
t0: [19:30:00 05/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [19:30:00 05/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [19:30:00 05/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [19:30:00 05/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [19:30:00 05/05/2011] id: PainLevel Acceptable el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:30:00 05/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [19:30:00 05/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [19:30:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:30:00 05/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:30:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:30:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:30:00 05/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [19:30:00 05/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 05/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [19:30:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [19:30:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:30:00 05/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [19:30:00 05/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 05/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [19:30:00 05/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [19:30:00 05/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [19:30:00 05/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 05/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [19:30:00 05/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [19:30:00 05/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [19:30:00 05/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [19:30:00 05/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [19:30:00 05/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [19:30:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [19:30:00 05/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [19:30:00 05/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:30:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [19:30:00 05/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [19:30:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:30:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [19:30:00 05/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [19:30:00 05/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [19:30:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [19:30:00 05/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [19:30:00 05/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [19:30:00 05/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [19:30:00 05/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [19:30:00 05/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [19:30:00 05/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [19:30:00 05/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [19:30:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [19:30:00 05/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [19:30:00 05/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [19:30:00 05/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [19:30:00 05/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [19:30:00 05/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3333 u1: Deg. C st: NotStopd t0: [19:30:00 05/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.4 u1: Deg. F st: NotStopd t0: [19:30:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:30:00 05/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [19:30:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 90 vu: ml t0: [19:30:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 15 vu: ml t0: [19:30:00 05/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20.8656 vu: ml t0: [19:30:00 05/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [19:30:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [19:30:00 05/05/2011] 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: [19:30:00 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 05/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 05/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 05/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 05/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 05/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 05/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 05/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 05/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 05/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 05/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 05/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [20:00:00 05/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 05/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 05/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 103 u1: BPM st: NotStopd t0: [20:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 05/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 05/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 05/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 05/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 05/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 05/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 05/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [20:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [20:00:00 05/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [20:00:00 05/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 05/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 05/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [20:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [20:00:00 05/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 05/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [20:00:00 05/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [20:00:00 05/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 05/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 05/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 05/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 05/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 05/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [20:00:00 05/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [20:00:00 05/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 05/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 05/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [20:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [20:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [20:00:00 05/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5.2164 vu: ml t0: [20:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [20:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [20:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [17:01:00 05/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 20.6 rs: Final st: NotStopd
t0: [20:11:00 05/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 31.25 u1: ml/cmH st: NotStopd t0: [20:11:00 05/05/2011] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [20:11:00 05/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:11:00 05/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [20:11:00 05/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [20:11:00 05/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [20:11:00 05/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [20:11:00 05/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [20:11:00 05/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:11:00 05/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [20:11:00 05/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [20:11:00 05/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:11:00 05/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [20:11:00 05/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:11:00 05/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:11:00 05/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [20:11:00 05/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.1 u1: L/min st: NotStopd t0: [20:11:00 05/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:11:00 05/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:11:00 05/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [20:11:00 05/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [20:11:00 05/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [20:11:00 05/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [20:11:00 05/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [20:11:00 05/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:11:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [20:11:00 05/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 508 u1: ml/B st: NotStopd t0: [20:11:00 05/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [20:11:00 05/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:11:00 05/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:11:00 05/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:30:00 05/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:30:00 05/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:30:00 05/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:30:00 05/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:30:00 05/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [20:30:00 05/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:30:00 05/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:30:00 05/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [20:30:00 05/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [20:30:00 05/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [21:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 05/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [21:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [21:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [21:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [21:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [21:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [21:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [21:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [21:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 05/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [21:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [21:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [21:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 25 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [11:00:00 06/05/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 50 u1: mg
t0: [22:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [22:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 86 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [22:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [22:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [22:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [22:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [22:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 05/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 8.694 vu: ml t0: [22:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [22:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 25 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 05/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 05/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 05/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 05/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 05/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 05/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 05/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [23:00:00 05/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 05/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 88 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [23:00:00 05/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [23:00:00 05/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 05/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [23:00:00 05/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [23:00:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 05/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 05/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vu: ml t0: [23:00:00 05/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [23:00:00 05/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 05/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 8.694 vu: ml t0: [23:00:00 05/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 140 vu: ml t0: [23:00:00 05/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [23:00:00 05/05/2011] 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 05/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [22:00:00 05/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 05/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 05/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 05/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [22:00:00 05/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [22:00:00 05/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 05/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 05/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 05/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 05/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 05/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 05/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 05/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 06/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 06/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 06/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [00:00:00 06/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 06/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 06/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 06/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 06/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 06/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 06/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 06/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 06/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 06/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [00:00:00 06/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 06/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 06/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [00:00:00 06/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 06/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 06/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 06/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [00:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 06/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 06/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 06/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 06/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 06/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [00:00:00 06/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 06/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 06/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 06/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 06/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 06/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 06/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 06/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 06/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 06/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 06/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 06/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 06/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [00:00:00 06/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 06/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 06/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 06/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 06/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [00:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [00:00:00 06/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:00:00 06/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 06/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 06/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [00:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 06/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [00:00:00 06/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 06/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 06/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 06/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 06/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [00:00:00 06/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 06/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 06/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 06/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 06/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 06/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 06/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 06/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 06/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 06/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [00:00:00 06/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [00:00:00 06/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 06/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [00:00:00 06/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [00:00:00 06/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 06/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 06/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 109 rs: Manual st: NotStopd t0: [00:00:00 06/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 06/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [00:00:00 06/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [00:00:00 06/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 06/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 06/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [00:00:00 06/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [00:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [00:00:00 06/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [00:00:00 06/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [00:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [00:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [00:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 06/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 120 ap: none
t0: [23:57:00 05/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 27.7778 u1: ml/cmH st: NotStopd t0: [23:57:00 05/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [23:57:00 05/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [23:57:00 05/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [23:57:00 05/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [23:57:00 05/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [23:57:00 05/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [23:57:00 05/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [23:57:00 05/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [23:57:00 05/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [23:57:00 05/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [23:57:00 05/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [23:57:00 05/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [23:57:00 05/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [23:57:00 05/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [23:57:00 05/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.3 u1: L/min st: NotStopd t0: [23:57:00 05/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [23:57:00 05/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [23:57:00 05/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [23:57:00 05/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [23:57:00 05/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [23:57:00 05/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [23:57:00 05/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [23:57:00 05/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [23:57:00 05/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [23:57:00 05/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [23:57:00 05/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [23:57:00 05/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 506 u1: ml/B st: NotStopd t0: [23:57:00 05/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [23:57:00 05/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [23:57:00 05/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [23:57:00 05/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [01:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [01:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [01:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [01:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 06/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [01:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [01:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 06/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [02:00:00 06/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 06/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 06/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [02:00:00 06/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [02:00:00 06/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 06/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 06/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 06/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 06/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 06/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 06/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 06/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd
t0: [01:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [01:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [01:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [02:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [02:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 160 vu: ml t0: [02:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [01:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 06/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 100 cv: 100 ap: none t0: [23:00:00 06/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -17.5672 cv: -17.5672 ap: none t0: [23:00:00 06/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 22.4328 cv: 1261.88 ap: none t0: [23:00:00 06/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 82.4328 cv: 3571.88 ap: none t0: [23:00:00 06/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 1440 ap: none t0: [23:00:00 06/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 100 cv: 2720 ap: none t0: [23:00:00 06/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -17.5672 cv: 276.88 ap: none t0: [23:00:00 06/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 100 cv: 3295 ap: none t0: [23:00:00 06/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -17.5672 cv: 11011 ap: carryForward
t0: [02:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [02:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [02:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [02:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 06/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [02:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [02:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [02:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:48:00 06/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.43 rs: Final st: NotStopd t0: [03:48:00 06/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [03:48:00 06/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -2 rs: Final st: NotStopd t0: [03:48:00 06/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [03:48:00 06/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 30 u1: mmHg rs: Final st: NotStopd t0: [03:48:00 06/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 138 u1: mmHg rs: Final st: NotStopd t0: [03:48:00 06/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.43 rs: Final st: NotStopd t0: [03:48:00 06/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd
t0: [03:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [03:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [03:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [03:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 06/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [03:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [03:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [03:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 06/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 97 u1: BPM st: NotStopd t0: [04:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 06/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 06/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 06/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [04:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [04:00:00 06/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [04:00:00 06/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 06/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [04:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [04:00:00 06/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 06/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [04:00:00 06/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 06/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 06/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml t0: [04:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [04:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [04:00:00 06/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [04:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [04:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [03:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [04:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 06/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [04:00:00 06/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [03:52:00 06/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 27.7778 u1: ml/cmH st: NotStopd t0: [03:52:00 06/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [03:52:00 06/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [03:52:00 06/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [03:52:00 06/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [03:52:00 06/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [03:52:00 06/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [03:52:00 06/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [03:52:00 06/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [03:52:00 06/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [03:52:00 06/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [03:52:00 06/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [03:52:00 06/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [03:52:00 06/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [03:52:00 06/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [03:52:00 06/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.3 u1: L/min st: NotStopd t0: [03:52:00 06/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [03:52:00 06/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [03:52:00 06/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [03:52:00 06/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [03:52:00 06/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [03:52:00 06/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [03:52:00 06/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [03:52:00 06/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [03:52:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [03:52:00 06/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [03:52:00 06/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [03:52:00 06/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 485 u1: ml/B st: NotStopd t0: [03:52:00 06/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [03:52:00 06/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [03:52:00 06/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [03:52:00 06/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [03:45:00 06/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.2 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 8.2 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 31 u1: % rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10 u1: gm/dl rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 372 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.72 u1: /mic l rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.2 rs: Final st: NotStopd
t0: [03:45:00 06/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 56 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.6 u1: mg/dl rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 112 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 93 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 u1: mEq/L rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 141 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 56 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.6 u1: mg/dl rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 112 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 93 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 u1: mEq/L rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 141 rs: Final st: NotStopd
t0: [04:00:00 06/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 06/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 06/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 06/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 06/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 06/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 06/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 06/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 06/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 06/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [04:00:00 06/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 06/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [04:00:00 06/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 06/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 06/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 06/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 06/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 06/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 06/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 06/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [04:00:00 06/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 06/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 06/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 06/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 06/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 06/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 06/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 06/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 06/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 06/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 06/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 06/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [04:00:00 06/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 06/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 06/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 06/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 06/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 06/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 06/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 06/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 06/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 06/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 06/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 06/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 06/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 06/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [04:00:00 06/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 06/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 06/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 06/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [04:00:00 06/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [04:00:00 06/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 06/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 06/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [04:00:00 06/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [05:00:00 06/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd
t0: [02:00:00 06/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vo: 500 vu: ml t0: [04:00:00 06/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 75 vu: ml
t0: [23:00:00 06/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 500 ap: none t0: [23:00:00 06/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 75 ap: none
t0: [04:00:00 06/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 06/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 06/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [04:00:00 06/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 06/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 06/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 06/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [04:00:00 06/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [04:00:00 06/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [04:00:00 06/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.6 u1: Deg. F st: NotStopd
t0: [05:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [05:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [05:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [05:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 06/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [05:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [05:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [05:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [05:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [05:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [05:00:00 06/05/2011] 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: [05:00:00 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [06:00:00 06/05/2011] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: No Spon Resp st: NotStopd
t0: [06:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [06:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [06:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [06:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 06/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [06:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [06:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [06:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [06:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [06:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [06:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [06:00:00 06/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd
t0: [06:00:00 06/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 100 rs: Manual st: NotStopd
t0: [08:00:00 06/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 29.4118 u1: ml/cmH st: NotStopd t0: [08:00:00 06/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 06/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [08:00:00 06/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 06/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:00:00 06/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [08:00:00 06/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 06/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 06/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 06/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:00:00 06/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [08:00:00 06/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 06/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 06/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [08:00:00 06/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.1 u1: L/min st: NotStopd t0: [08:00:00 06/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 06/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 06/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [08:00:00 06/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [08:00:00 06/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [08:00:00 06/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [08:00:00 06/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:00:00 06/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [08:00:00 06/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: None st: NotStopd t0: [08:00:00 06/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 452 u1: ml/B st: NotStopd t0: [08:00:00 06/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [08:00:00 06/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 06/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 06/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 06/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 06/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 06/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 06/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 06/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 06/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 06/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 06/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 06/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 06/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 06/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [08:00:00 06/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 06/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 06/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 06/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 06/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 06/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [08:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 06/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 06/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 06/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 06/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [08:00:00 06/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 06/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 06/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 06/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 06/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 06/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 06/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 06/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 06/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 06/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 06/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 06/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [08:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [08:00:00 06/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 06/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 06/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70 u1: kg st: NotStopd t0: [08:00:00 06/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 06/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 06/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 06/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 06/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [08:00:00 06/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 06/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 06/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 06/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 06/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [08:00:00 06/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [08:00:00 06/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 06/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 06/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [08:00:00 06/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [08:00:00 06/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:00:00 06/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 06/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 06/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 06/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [08:00:00 06/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [08:00:00 06/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 06/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 06/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [08:00:00 06/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [08:00:00 06/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml t0: [08:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [08:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [08:00:00 06/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [08:00:00 06/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [08:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml t0: [08:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [08:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [09:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [09:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [09:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [09:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [09:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [09:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [09:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [09:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [09:00:00 06/05/2011] 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: [09:00:00 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [10:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [10:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [10:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [10:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [10:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [10:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:30:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:30:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:30:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 114 u1: BPM st: NotStopd t0: [10:30:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [10:30:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [10:30:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:30:00 06/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd t0: [10:30:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [10:30:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 90 u1: % st: NotStopd t0: [10:30:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [10:30:00 06/05/2011] 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: [10:30:00 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [11:00:00 06/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 23.8095 u1: ml/cmH st: NotStopd t0: [11:00:00 06/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [11:00:00 06/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [11:00:00 06/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [11:00:00 06/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [11:00:00 06/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [11:00:00 06/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [11:00:00 06/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [11:00:00 06/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 06/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [11:00:00 06/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [11:00:00 06/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:00:00 06/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:00:00 06/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [11:00:00 06/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.6 u1: L/min st: NotStopd t0: [11:00:00 06/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [11:00:00 06/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 06/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [11:00:00 06/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [11:00:00 06/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [11:00:00 06/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [11:00:00 06/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [11:00:00 06/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [11:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 91 u1: % st: NotStopd t0: [11:00:00 06/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thin st: NotStopd t0: [11:00:00 06/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [11:00:00 06/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 472 u1: ml/B st: NotStopd t0: [11:00:00 06/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [11:00:00 06/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [11:00:00 06/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [11:00:00 06/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [11:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 114 u1: BPM st: NotStopd t0: [11:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [11:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [11:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [11:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 06/05/2011] 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: [11:00:00 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 06/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 116 rs: Manual st: NotStopd
t0: [12:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [12:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [12:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [12:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [12:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 90 u1: % st: NotStopd t0: [12:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 180 vu: ml t0: [12:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 30 vu: ml t0: [12:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20.8656 vu: ml t0: [12:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml t0: [12:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml
t0: [12:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 06/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml
t0: [03:45:00 06/05/2011] id: Differential-Bands Hematology el: 0 cu: MICU cg: 1663 v1: 12 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Differential-Basos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Differential-Eos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Differential-Lymphs Hematology el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Differential-Monos Hematology el: 0 cu: MICU cg: 1663 v1: 6 rs: Final st: NotStopd t0: [03:45:00 06/05/2011] id: Differential-Polys Hematology el: 0 cu: MICU cg: 1663 v1: 76 rs: Final st: NotStopd
t0: [13:00:00 06/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: -1 vo: 0 st: D/C'd
t0: [09:00:00 06/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vu: ml t0: [12:00:00 06/05/2011] id: free h20 bolus Free Form Intake el: 1 cu: MICU cg: RN vu: ml
t0: [14:00:00 06/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [14:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml t0: [14:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [14:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [14:00:00 06/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [14:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
tf: [14:00:00 07/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 15 dn: 1 m1: Furosemide v1: 20 u1: mg
t0: [14:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [14:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [14:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [14:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [14:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [14:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [16:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [16:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [16:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [16:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [16:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [16:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [14:00:00 06/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Captopril v1: 12.5 u1: mg tf: [11:00:00 07/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Captopril v1: 25 u1: mg
t0: [17:00:00 06/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 27.7778 u1: ml/cmH st: NotStopd t0: [17:00:00 06/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [17:00:00 06/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [17:00:00 06/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [17:00:00 06/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [17:00:00 06/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [17:00:00 06/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [17:00:00 06/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 06/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 06/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 06/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [17:00:00 06/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [17:00:00 06/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [17:00:00 06/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [17:00:00 06/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.2 u1: L/min st: NotStopd t0: [17:00:00 06/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [17:00:00 06/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 06/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [17:00:00 06/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [17:00:00 06/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [17:00:00 06/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [17:00:00 06/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [17:00:00 06/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [17:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 94 u1: % st: NotStopd t0: [17:00:00 06/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thin st: NotStopd t0: [17:00:00 06/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [17:00:00 06/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 504 u1: ml/B st: NotStopd t0: [17:00:00 06/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [17:00:00 06/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [17:00:00 06/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 06/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [12:00:00 06/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [12:00:00 06/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 06/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 06/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 06/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 06/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 06/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 06/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 06/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 06/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [12:00:00 06/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.2 u1: Deg. F st: NotStopd t0: [18:00:00 06/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [18:00:00 06/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 06/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [18:00:00 06/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 06/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [18:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 06/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [18:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 06/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [18:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 06/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [18:00:00 06/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [18:00:00 06/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [18:00:00 06/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [18:00:00 06/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 06/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [18:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [18:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 06/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [18:00:00 06/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 06/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [18:00:00 06/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [18:00:00 06/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 06/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [18:00:00 06/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [18:00:00 06/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [18:00:00 06/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [18:00:00 06/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 06/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 06/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [18:00:00 06/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [18:00:00 06/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [18:00:00 06/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [18:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [18:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [18:00:00 06/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 06/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 06/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 06/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 06/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 06/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [18:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [18:00:00 06/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 06/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 06/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 06/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [18:00:00 06/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [18:00:00 06/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [18:00:00 06/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [18:00:00 06/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [18:00:00 06/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [18:00:00 06/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [18:00:00 06/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [18:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 06/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [18:00:00 06/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [18:00:00 06/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [18:00:00 06/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [18:00:00 06/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [18:00:00 06/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [18:00:00 06/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [18:00:00 06/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [18:00:00 06/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [18:00:00 06/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [18:00:00 06/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [18:00:00 06/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [17:00:00 06/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [17:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 180 vu: ml t0: [17:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 30 vu: ml t0: [17:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20.8656 vu: ml t0: [17:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml t0: [18:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [18:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [18:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 1150 vu: ml t0: [18:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [18:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [18:00:00 06/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 135 rs: Manual st: NotStopd
t0: [20:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml t0: [20:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [20:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [20:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml t0: [20:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [19:49:00 06/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 20.8333 u1: ml/cmH st: NotStopd t0: [19:49:00 06/05/2011] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [19:49:00 06/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [19:49:00 06/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [19:49:00 06/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [19:49:00 06/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [19:49:00 06/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [19:49:00 06/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [19:49:00 06/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [19:49:00 06/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [19:49:00 06/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [19:49:00 06/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [19:49:00 06/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [19:49:00 06/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [19:49:00 06/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [19:49:00 06/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 17.1 u1: L/min st: NotStopd t0: [19:49:00 06/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [19:49:00 06/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [19:49:00 06/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [19:49:00 06/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [19:49:00 06/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [19:49:00 06/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [19:49:00 06/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [19:49:00 06/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [19:49:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [19:49:00 06/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [19:49:00 06/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [19:49:00 06/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 521 u1: ml/B st: NotStopd t0: [19:49:00 06/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [19:49:00 06/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [19:49:00 06/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [19:49:00 06/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 06/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 06/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 06/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 06/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 2 u1: mmHg st: NotStopd t0: [20:00:00 06/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 06/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 06/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Other Remarks st: NotStopd t0: [20:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 06/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 06/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 06/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 124 u1: BPM st: NotStopd t0: [20:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 06/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 06/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 06/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [20:00:00 06/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Hematoma st: NotStopd t0: [20:00:00 06/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [20:00:00 06/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 06/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 06/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 06/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Purple st: NotStopd t0: [20:00:00 06/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [20:00:00 06/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 06/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 06/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 06/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [20:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [20:00:00 06/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 06/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 06/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 06/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 06/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [20:00:00 06/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 06/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 06/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [20:00:00 06/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 06/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 06/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 06/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 06/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [20:00:00 06/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 06/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 06/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [20:00:00 06/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [20:00:00 06/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [20:00:00 06/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 06/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 06/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Restless st: NotStopd t0: [21:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 118 u1: BPM st: NotStopd t0: [21:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [21:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [21:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [21:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [21:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 06/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [20:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [21:00:00 06/05/2011] 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 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [21:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [21:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [21:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [21:00:00 06/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [21:00:00 06/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [21:00:00 06/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [21:00:00 06/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [21:00:00 06/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [21:00:00 06/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [21:00:00 06/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [21:00:00 06/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [21:00:00 06/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [21:00:00 06/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [21:00:00 06/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [21:00:00 06/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [21:00:00 06/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [21:00:00 06/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [21:00:00 06/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 06/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [21:00:00 06/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 06/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [21:00:00 06/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 06/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [21:00:00 06/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 06/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [21:00:00 06/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 06/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 06/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 06/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 06/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [21:00:00 06/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [21:00:00 06/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [21:00:00 06/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 06/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [21:00:00 06/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 06/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 06/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [21:00:00 06/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [21:00:00 06/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [21:00:00 06/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [21:00:00 06/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [21:00:00 06/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 06/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [21:00:00 06/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [21:00:00 06/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [21:00:00 06/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [21:00:00 06/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [21:00:00 06/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [21:00:00 06/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd
t0: [22:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [22:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [22:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [22:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [21:00:00 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [11:00:00 07/05/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 75 u1: mg
t0: [22:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 103 u1: BPM st: NotStopd t0: [22:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [22:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [22:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [22:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 06/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 06/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 06/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 06/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 06/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 06/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 06/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [23:00:00 06/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 06/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [23:00:00 06/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [23:00:00 06/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 06/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [23:00:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 06/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 06/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [23:00:00 06/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 06/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [23:00:00 06/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [23:00:00 06/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [22:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [23:00:00 06/05/2011] 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 06/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [18:00:00 24/05/2011] pt: Unit Dose rt: TP fr: QID:PRN m1: Nystatin Ointment v1: 1 u1: Appl
t0: [23:39:00 06/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 26.3158 u1: ml/cmH st: NotStopd t0: [23:39:00 06/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [23:39:00 06/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 25 t0: [23:39:00 06/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [23:39:00 06/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [23:39:00 06/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [23:39:00 06/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [23:39:00 06/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [23:39:00 06/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [23:39:00 06/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [23:39:00 06/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [23:39:00 06/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [23:39:00 06/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [23:39:00 06/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [23:39:00 06/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.7 u1: L/min st: NotStopd t0: [23:39:00 06/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [23:39:00 06/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [23:39:00 06/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [23:39:00 06/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [23:39:00 06/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [23:39:00 06/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [23:39:00 06/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [23:39:00 06/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [23:39:00 06/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [23:39:00 06/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [23:39:00 06/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [23:39:00 06/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 473 u1: ml/B st: NotStopd t0: [23:39:00 06/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [23:39:00 06/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [23:39:00 06/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [23:39:00 06/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 07/05/2011] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd
t0: [00:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 120 u1: BPM st: NotStopd t0: [00:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [00:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [00:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [00:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [00:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [00:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [00:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [00:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [00:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [00:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [22:00:00 06/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 06/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 06/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 06/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [22:00:00 06/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [22:00:00 06/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 06/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 06/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 06/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 06/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 06/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [22:00:00 06/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 06/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 07/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 07/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 07/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 07/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 07/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 07/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 07/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 07/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 07/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 07/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 07/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 07/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 07/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 07/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 07/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 07/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 07/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [00:00:00 07/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 07/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 07/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 07/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 07/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 07/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 07/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 07/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 07/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 07/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 07/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 07/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 07/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 07/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 07/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 07/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 07/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:00:00 07/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 07/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 07/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 07/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 07/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 07/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 07/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 07/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 07/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 07/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [00:00:00 07/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 07/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 07/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 07/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 07/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 07/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3889 u1: Deg. C st: NotStopd t0: [00:00:00 07/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.3 u1: Deg. F st: NotStopd t0: [00:00:00 07/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 07/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 07/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 07/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 07/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 07/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 07/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [00:00:00 07/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [00:00:00 07/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Changed st: NotStopd t0: [00:00:00 07/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 07/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [01:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 07/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 119 u1: BPM st: NotStopd t0: [01:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 07/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [01:00:00 07/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [01:00:00 07/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [01:00:00 07/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [01:00:00 07/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [01:00:00 07/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [01:00:00 07/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [01:00:00 07/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [01:00:00 07/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [01:00:00 07/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [01:00:00 07/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 07/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [01:00:00 07/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [01:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [01:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [01:00:00 07/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 07/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [01:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [01:00:00 07/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [01:00:00 07/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [01:00:00 07/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [01:00:00 07/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [01:00:00 07/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 07/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [01:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [01:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 150 vu: ml t0: [01:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [01:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 07/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 101 rs: Manual st: NotStopd
tf: [00:00:00 08/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 1 dn: 1 m1: Furosemide v1: 20 u1: mg
t0: [02:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [02:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [02:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [02:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [02:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [02:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [03:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [03:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [03:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [03:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [03:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [03:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [02:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 480 vu: ml t0: [02:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [03:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [03:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [03:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 400 vu: ml t0: [03:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [02:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 07/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 240 cv: 240 ap: none t0: [23:00:00 07/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -149.567 cv: -149.567 ap: none t0: [23:00:00 07/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 30.4328 cv: 6465.13 ap: none t0: [23:00:00 07/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 90.4328 cv: 8025.13 ap: none t0: [23:00:00 07/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 1380 ap: none t0: [23:00:00 07/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 240 cv: 3470 ap: none t0: [23:00:00 07/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -149.567 cv: 3580.13 ap: carryForward t0: [23:00:00 07/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 240 cv: 4445 ap: carryForward t0: [23:00:00 07/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -149.567 cv: 14591.1 ap: carryForward
t0: [02:00:00 07/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [02:00:00 07/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 07/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 07/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [02:00:00 07/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [02:00:00 07/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 07/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 07/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 07/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 07/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 07/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [02:00:00 07/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 07/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 07/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 07/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 07/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 07/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 07/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 07/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 07/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 07/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 07/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [04:00:00 07/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 07/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 07/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 07/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 07/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 07/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 07/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [04:00:00 07/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 07/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 07/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 07/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 110 u1: BPM st: NotStopd t0: [04:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 07/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 07/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 07/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 07/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 07/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 07/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 07/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 07/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 07/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 07/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 07/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 07/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 07/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [04:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [04:00:00 07/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [04:00:00 07/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 07/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 07/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 07/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 07/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 07/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 07/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 07/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [04:00:00 07/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 07/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 07/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [04:00:00 07/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 07/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [04:00:00 07/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 07/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 07/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 07/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [04:00:00 07/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 07/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 07/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 07/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 07/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 07/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 07/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [04:00:00 07/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [04:00:00 07/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 07/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 07/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [04:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [04:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [04:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [04:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 260 vu: ml t0: [04:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [04:00:00 07/05/2011] 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: [04:04:00 07/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.48 rs: Final st: NotStopd t0: [04:04:00 07/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [04:04:00 07/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [04:04:00 07/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 29 u1: mmHg rs: Final st: NotStopd t0: [04:04:00 07/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 65 u1: mmHg rs: Final st: NotStopd t0: [04:04:00 07/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.48 rs: Final st: NotStopd
t0: [04:00:00 07/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 07/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5 u1: Deg. C st: NotStopd t0: [04:00:00 07/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.5 u1: Deg. F st: NotStopd
t0: [04:00:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [05:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 07/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [05:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 07/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 07/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [05:00:00 07/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [05:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [05:00:00 07/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [05:00:00 07/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [05:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [05:00:00 07/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [05:00:00 07/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [05:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [05:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [05:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml t0: [05:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [05:00:00 07/05/2011] 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: [05:00:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [04:45:00 07/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 25 u1: ml/cmH st: NotStopd t0: [04:45:00 07/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [04:45:00 07/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 25 t0: [04:45:00 07/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [04:45:00 07/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [04:45:00 07/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [04:45:00 07/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [04:45:00 07/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:45:00 07/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [04:45:00 07/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [04:45:00 07/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [04:45:00 07/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [04:45:00 07/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:45:00 07/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [04:45:00 07/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 17.1 u1: L/min st: NotStopd t0: [04:45:00 07/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:45:00 07/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:45:00 07/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [04:45:00 07/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [04:45:00 07/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 9 u1: BPM st: NotStopd t0: [04:45:00 07/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [04:45:00 07/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [04:45:00 07/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:45:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [04:45:00 07/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [04:45:00 07/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [04:45:00 07/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 506 u1: ml/B st: NotStopd t0: [04:45:00 07/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [04:45:00 07/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:45:00 07/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:45:00 07/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [05:00:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [05:00:00 07/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 125 vu: ml
t0: [04:00:00 07/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 14.3 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 14.3 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 31 u1: % rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.3 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 476 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.7 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 14.3 rs: Final st: NotStopd
t0: [04:00:00 07/05/2011] id: PT el: 0 cu: MICU cg: 1663 v1: 12.7 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 30.2 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 12.7 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 30.2 rs: Final st: NotStopd
t0: [04:00:00 07/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 49 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 106 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 88 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 49 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 106 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 88 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd
t0: [06:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 124 u1: BPM st: NotStopd t0: [06:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [06:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [06:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [06:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [06:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [06:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 260 vu: ml t0: [06:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [06:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [06:00:00 07/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 128.125 u1: units st: NotStopd t0: [06:00:00 07/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 128.125 u1: units st: NotStopd t0: [06:00:00 07/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 41 u1: BPM st: NotStopd t0: [06:00:00 07/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.32 u1: L st: NotStopd
t0: [06:00:00 07/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 98 rs: Manual st: NotStopd t0: [07:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 117 u1: BPM st: NotStopd t0: [07:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [07:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [07:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [07:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [07:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml t0: [07:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [07:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [07:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [07:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 110 vu: ml t0: [07:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [07:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [06:00:00 08/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 7 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [06:00:00 08/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 7 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [04:00:00 07/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: RN v1: 3.5 rs: Final st: NotStopd t0: [04:00:00 07/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: RN v1: 3.5 rs: Final st: NotStopd t0: [08:00:00 07/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 07/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 07/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 07/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 07/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 07/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 07/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 07/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 07/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 07/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 07/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 07/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 131 u1: BPM st: NotStopd t0: [08:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 07/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 07/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 07/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 07/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 07/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 07/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [08:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [08:00:00 07/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 07/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 07/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 07/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 07/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 07/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [08:00:00 07/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 07/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 07/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [08:00:00 07/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 07/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Pale st: NotStopd t0: [08:00:00 07/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 07/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 85 u1: % st: NotStopd t0: [08:00:00 07/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [08:00:00 07/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [08:00:00 07/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [08:00:00 07/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 07/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:00:00 07/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 07/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 07/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 07/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 07/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 07/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 07/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 07/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [08:00:00 07/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 07/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 07/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [08:00:00 07/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 07/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 07/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [08:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [08:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 160 vu: ml t0: [08:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [08:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:10:00 07/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 26.3158 u1: ml/cmH st: NotStopd t0: [08:10:00 07/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:10:00 07/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 25 t0: [08:10:00 07/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [08:10:00 07/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:10:00 07/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [08:10:00 07/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [08:10:00 07/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:10:00 07/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:10:00 07/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [08:10:00 07/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:10:00 07/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [08:10:00 07/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [08:10:00 07/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [08:10:00 07/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 18 u1: L/min st: NotStopd t0: [08:10:00 07/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:10:00 07/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:10:00 07/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [08:10:00 07/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [08:10:00 07/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [08:10:00 07/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [08:10:00 07/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [08:10:00 07/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:10:00 07/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:10:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [08:10:00 07/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [08:10:00 07/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:10:00 07/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 586 u1: ml/B st: NotStopd t0: [08:10:00 07/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [08:10:00 07/05/2011] id: Total PEEP Level el: 0 cu: MICU cg: RRT v1: 4.7 u1: cmH2O st: NotStopd t0: [08:10:00 07/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:10:00 07/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:10:00 07/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:20:00 07/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.7 u1: torr st: NotStopd
t0: [08:00:00 07/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 07/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 07/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 07/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [08:00:00 07/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 07/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 07/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 07/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 07/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [08:00:00 07/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 07/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 07/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 07/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 07/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 07/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 07/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [09:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 07/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [09:00:00 07/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 07/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 124 u1: BPM st: NotStopd t0: [09:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 07/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 07/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 07/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [09:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [09:00:00 07/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [09:00:00 07/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [09:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [09:00:00 07/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [09:00:00 07/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.6667 u1: Deg. C st: NotStopd t0: [09:00:00 07/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 101.6 u1: Deg. F st: NotStopd t0: [09:00:00 07/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [09:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 150 vu: ml t0: [08:00:00 07/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 120 vu: ml t0: [09:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [09:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [09:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 140 vu: ml t0: [09:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [09:00:00 07/05/2011] 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: [09:00:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:45:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:45:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:45:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:45:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:45:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:45:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:45:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 116 u1: BPM st: NotStopd t0: [09:45:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:45:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 70 u1: mmHg v2: 36 u2: mmHg st: NotStopd t0: [09:45:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 48 u1: mmHg st: NotStopd t0: [09:45:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:45:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [09:45:00 07/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [09:45:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [09:45:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:45:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml
t0: [09:45:00 07/05/2011] 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: [09:45:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [11:00:00 11/05/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Prednisone v1: 20 u1: mg
t0: [10:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 07/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 2 u1: mmHg st: NotStopd t0: [10:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 117 u1: BPM st: NotStopd t0: [10:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [10:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [10:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [10:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml t0: [10:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [10:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.041 vu: ml t0: [10:00:00 07/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Large t0: [10:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [10:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [10:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [11:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [11:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 75 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [11:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 57 u1: mmHg st: NotStopd t0: [11:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [11:00:00 07/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [11:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [11:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [11:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [11:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 20 vu: ml t0: [11:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [11:00:00 07/05/2011] 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: [11:00:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
id: Levophed-k el: 200 cu: MICU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions am: 4 du: mcgkgmin rt: IV Drip
id: D5W el: 2 cu: MICU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [11:00:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 1000 vu: ml
t0: [11:15:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:15:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:15:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:15:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:15:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:15:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:15:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [11:15:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:15:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 70 u1: mmHg v2: 42 u2: mmHg st: NotStopd t0: [11:15:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 53 u1: mmHg st: NotStopd t0: [11:15:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:15:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [11:15:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [11:15:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:30:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:30:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:30:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [11:30:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:30:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 98 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [11:30:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [11:30:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:30:00 07/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd t0: [11:30:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [11:30:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [11:30:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:15:00 07/05/2011] tf: [04:00:00 08/05/2011] dt: 1005 id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0460087 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:15:00 07/05/2011] 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: [11:15:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [11:30:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0460087 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:30:00 07/05/2011] 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: [11:30:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:00:00 07/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 07/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 07/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 07/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 07/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [10:00:00 07/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 07/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 07/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 07/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 07/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 07/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 07/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 07/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [10:00:00 07/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [10:15:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:15:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:15:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:15:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:15:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:15:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:15:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 114 u1: BPM st: NotStopd t0: [10:15:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:15:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [10:15:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [10:15:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:15:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [10:15:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:15:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:30:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:30:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:30:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:30:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:30:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [10:30:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:30:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 95 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [10:30:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [10:30:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:30:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [10:30:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:30:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:45:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:45:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:45:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:45:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:45:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:45:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:45:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 114 u1: BPM st: NotStopd t0: [10:45:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:45:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 77 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [10:45:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [10:45:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:45:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [10:45:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [10:45:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 07/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [11:00:00 07/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 07/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 07/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [11:00:00 07/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [11:00:00 07/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 07/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [11:00:00 07/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [11:30:00 07/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [11:45:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:45:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:45:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:45:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:45:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:45:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:45:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [11:45:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:45:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [11:45:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [11:45:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:45:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [11:45:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [11:45:00 07/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [11:45:00 07/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [11:45:00 07/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [11:45:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 07/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 07/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 07/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 07/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 07/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 07/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 07/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 07/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 07/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [12:00:00 07/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 07/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 07/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [12:00:00 07/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 07/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 07/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [12:00:00 07/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 07/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 07/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [12:00:00 07/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 07/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 07/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 07/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 07/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 07/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 07/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 07/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 07/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [12:00:00 07/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [12:00:00 07/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 07/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 07/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 07/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 07/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 07/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 07/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 07/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 07/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 07/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 07/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [12:00:00 07/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 07/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 07/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [12:00:00 07/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Rectal Tube st: NotStopd t0: [12:00:00 07/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 07/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [12:00:00 07/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 07/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 07/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 07/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [12:00:00 07/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [12:00:00 07/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 07/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 07/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [11:00:00 07/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 0 vu: ml nb: 1
t0: [10:15:00 07/05/2011] 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: [10:15:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [10:30:00 07/05/2011] 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: [10:30:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [10:45:00 07/05/2011] 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: [10:45:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [11:45:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0460087 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:45:00 07/05/2011] 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: [11:45:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [12:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [12:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [12:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [12:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [12:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [12:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 160 vu: ml t0: [12:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [12:00:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0460087 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [10:00:00 13/05/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Norepinephrine v1: 4 u1: mg m2: D5W v2: 250 u2: ml
t0: [12:15:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:15:00 07/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [12:15:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:15:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:15:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:15:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:15:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:15:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [12:15:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:15:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 90 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [12:15:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [12:15:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:15:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [12:15:00 07/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [12:15:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [12:15:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:15:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0460087 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:15:00 07/05/2011] 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: [12:15:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:31:00 07/05/2011] id: Mixed Venous O2 Blood Gases el: 0 cu: MICU cg: 1663 v1: 80 rs: Final st: NotStopd
t0: [12:31:00 07/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.38 rs: Final st: NotStopd t0: [12:31:00 07/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -2 rs: Final st: NotStopd t0: [12:31:00 07/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 23 rs: Final st: NotStopd t0: [12:31:00 07/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 37 u1: mmHg rs: Final st: NotStopd t0: [12:31:00 07/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 80 u1: mmHg rs: Final st: NotStopd t0: [12:31:00 07/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.38 rs: Final st: NotStopd
t0: [12:31:00 07/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [12:31:00 07/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd
t0: [12:00:00 07/05/2011] id: Albumin Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [12:00:00 07/05/2011] id: Total Bili Chemistry el: 0 cu: MICU cg: 1663 v1: 0.2 rs: Final st: NotStopd t0: [12:00:00 07/05/2011] id: ALT Enzymes el: 0 cu: MICU cg: 1663 v1: 11 rs: Final st: NotStopd t0: [12:00:00 07/05/2011] id: AST Enzymes el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [12:00:00 07/05/2011] id: Albumin (>3.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [12:00:00 07/05/2011] id: Alk. Phosphate Enzymes el: 0 cu: MICU cg: 1663 v1: 44 rs: Final st: NotStopd t0: [12:00:00 07/05/2011] id: Amylase Enzymes el: 0 cu: MICU cg: 1663 v1: 193 rs: Final st: NotStopd t0: [12:00:00 07/05/2011] id: LDH Enzymes el: 0 cu: MICU cg: 1663 v1: 195 rs: Final st: NotStopd t0: [12:00:00 07/05/2011] id: Total Bili (0-1.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.2 rs: Final st: NotStopd
t0: [12:36:00 07/05/2011] id: Mixed Venous O2 Blood Gases el: 0 cu: MICU cg: 1663 v1: 47 rs: Final st: NotStopd t0: [12:36:00 07/05/2011] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: MICU cg: 1663 v1: 79 rs: Final st: NotStopd
t0: [13:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 07/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [13:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [13:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [13:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [13:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [13:00:00 07/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [13:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [13:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:30:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:30:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:30:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:30:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:30:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [13:30:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:30:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 97 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [13:30:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [13:30:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:30:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [13:30:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [13:30:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 1000 vu: ml t0: [12:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml st: Stopped t0: [12:00:00 07/05/2011] tf: [21:00:00 08/05/2011] dt: 1980 id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 1000 vu: ml t0: [13:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [13:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [13:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [13:00:00 07/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [13:00:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0552105 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 07/05/2011] 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: [13:00:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [13:30:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0460087 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:30:00 07/05/2011] 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: [13:30:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [14:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [14:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [14:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [14:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [14:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [14:00:00 07/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [14:00:00 07/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [14:00:00 07/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [14:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 07/05/2011] tf: [10:00:00 10/05/2011] dt: 4080 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [14:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [14:00:00 07/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 11 vu: ml t0: [14:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 160 vu: ml t0: [14:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [14:00:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0460087 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [15:00:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: CoWkr ai: 105 vo: 1000 vu: ml t0: [15:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: CoWkr vo: 50 vu: ml
t0: [15:50:00 07/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 29.4118 u1: ml/cmH st: NotStopd t0: [15:50:00 07/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [15:50:00 07/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 25 t0: [15:50:00 07/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.7 u1: torr st: NotStopd t0: [15:50:00 07/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [15:50:00 07/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [15:50:00 07/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [15:50:00 07/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [15:50:00 07/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [15:50:00 07/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [15:50:00 07/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [15:50:00 07/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [15:50:00 07/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [15:50:00 07/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [15:50:00 07/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [15:50:00 07/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [15:50:00 07/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [15:50:00 07/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [15:50:00 07/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [15:50:00 07/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [15:50:00 07/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [15:50:00 07/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [15:50:00 07/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [15:50:00 07/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [15:50:00 07/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [15:50:00 07/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [15:50:00 07/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [15:50:00 07/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [15:50:00 07/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
tf: [10:00:00 09/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metronidazole v1: 500 u1: mg
t0: [13:00:00 07/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 07/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [13:00:00 07/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [13:00:00 07/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:00:00 07/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [13:00:00 07/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 07/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [14:00:00 07/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 07/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [14:00:00 07/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 07/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [14:00:00 07/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [14:00:00 07/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 07/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 07/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 07/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 07/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 07/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [14:00:00 07/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 07/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [15:00:00 07/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [16:00:00 07/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 07/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 07/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [16:00:00 07/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 07/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [16:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 07/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 07/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 07/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 07/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 07/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [16:00:00 07/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 07/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 07/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 07/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 07/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 07/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 07/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 07/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 07/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 07/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [16:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [16:00:00 07/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 07/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 07/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 07/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [16:00:00 07/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 07/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 07/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [16:00:00 07/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 07/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 07/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [16:00:00 07/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 07/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml t0: [16:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [16:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20.8656 vu: ml t0: [16:00:00 07/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [16:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [16:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:00:00 07/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 07/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 07/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 07/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 07/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [16:00:00 07/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [16:00:00 07/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 07/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 07/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 07/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 07/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 07/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 07/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 07/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 07/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [16:00:00 07/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [16:00:00 07/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 07/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 07/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 07/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 07/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 07/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [16:00:00 07/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Rectal Tube st: NotStopd t0: [16:00:00 07/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 07/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 07/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 07/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 07/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [16:00:00 07/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 07/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 07/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [16:15:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:15:00 07/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [16:15:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:15:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:15:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:15:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:15:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:15:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [16:15:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:15:00 07/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [16:15:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [16:15:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [16:15:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:15:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [16:15:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:45:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:45:00 07/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [16:45:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:45:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:45:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:45:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:45:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:45:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [16:45:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:45:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [16:45:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [16:45:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:45:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [16:45:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:45:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.036807 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:15:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0230044 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:15:00 07/05/2011] 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: [16:15:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [16:45:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0230044 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:45:00 07/05/2011] 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: [16:45:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:00:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [16:00:00 07/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 60 vu: ml t0: [16:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [17:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml
t0: [23:00:00 07/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 180 ap: none
t0: [17:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 07/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [17:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [17:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 91 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [17:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [17:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [17:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0460087 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 07/05/2011] 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: [17:00:00 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [18:00:00 07/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 154 rs: Manual st: NotStopd
tf: [14:00:00 09/05/2011] pt: IV Piggyback rt: IV fr: Q12H fs: 18, 6 dn: 2 m1: Vancomycin HCl v1: 1000 u1: mg m2: Iso-Osmotic Dextrose v2: 200 u2: ml
t0: [18:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 07/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [18:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [18:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [18:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 07/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [18:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml t0: [18:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [18:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20.8656 vu: ml t0: [18:00:00 07/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 15.75 vu: ml t0: [18:00:00 07/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 250 vu: ml t0: [18:00:00 07/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vo: 600 vu: ml t0: [18:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [18:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [18:00:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.036807 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 07/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 600 ap: carryForward t0: [23:00:00 07/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 375 ap: none
t0: [19:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [19:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [19:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [19:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [19:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [20:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [20:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [20:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [20:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.036807 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [20:00:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.036807 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [19:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [19:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [19:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [19:00:00 07/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 8 vu: ml t0: [19:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [20:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [20:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [20:00:00 07/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 8 vu: ml t0: [20:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [20:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 230 vu: ml
t0: [20:00:00 07/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 07/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 07/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 07/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 07/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 07/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 07/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 07/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [20:00:00 07/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 07/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 07/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 07/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 07/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 07/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 07/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 07/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 07/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 07/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 07/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 07/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 07/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 07/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 07/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd
t0: [20:28:00 07/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 23.8095 u1: ml/cmH st: NotStopd t0: [20:28:00 07/05/2011] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [20:28:00 07/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:28:00 07/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 25 t0: [20:28:00 07/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [20:28:00 07/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:28:00 07/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [20:28:00 07/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [20:28:00 07/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:28:00 07/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [20:28:00 07/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [20:28:00 07/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:28:00 07/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [20:28:00 07/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:28:00 07/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [20:28:00 07/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.4 u1: L/min st: NotStopd t0: [20:28:00 07/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:28:00 07/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:28:00 07/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [20:28:00 07/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [20:28:00 07/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [20:28:00 07/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [20:28:00 07/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [20:28:00 07/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:28:00 07/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [20:28:00 07/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [20:28:00 07/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 528 u1: ml/B st: NotStopd t0: [20:28:00 07/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [20:28:00 07/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:28:00 07/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:28:00 07/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [19:45:00 07/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Ultrasound st: NotStopd
t0: [20:00:00 07/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 07/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 07/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 07/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 07/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 07/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [20:00:00 07/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 07/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [20:00:00 07/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 07/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 07/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 07/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 07/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 07/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 07/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 07/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 07/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 07/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 07/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 07/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 07/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 07/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 07/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 07/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [20:00:00 07/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 07/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Rectal Tube st: NotStopd t0: [20:00:00 07/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [20:00:00 07/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 07/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 07/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 07/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 07/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 07/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [20:00:00 07/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [20:00:00 07/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 07/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 07/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [21:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 07/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [21:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 07/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [21:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 07/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 07/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 07/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [21:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [21:00:00 07/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [21:00:00 07/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [21:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [21:00:00 07/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [21:00:00 07/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.036807 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [18:00:00 07/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 27 rs: Final st: NotStopd
t0: [18:00:00 07/05/2011] id: Total Protein Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [18:00:00 07/05/2011] id: Total Protein(6.5-8) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd
t0: [20:00:00 07/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Thoracentesis st: NotStopd t0: [22:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 07/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [22:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [22:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [22:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [22:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [22:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 07/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 07/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 07/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [23:00:00 07/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 07/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 07/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 07/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 07/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [23:00:00 07/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 07/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [23:00:00 07/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [23:00:00 07/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 07/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [23:00:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 07/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [21:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [21:00:00 07/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 8 vu: ml t0: [21:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [22:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [22:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [22:00:00 07/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 8 vu: ml t0: [22:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [23:00:00 07/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [23:00:00 07/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 07/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [23:00:00 07/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 8 vu: ml t0: [23:00:00 07/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 240 vu: ml t0: [23:00:00 07/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [23:00:00 07/05/2011] 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 07/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [22:00:00 07/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 07/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 07/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 07/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [22:00:00 07/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [22:00:00 07/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 07/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 07/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 07/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 07/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 07/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 07/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 07/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd
t0: [23:54:00 07/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 27.7778 u1: ml/cmH st: NotStopd t0: [23:54:00 07/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [23:54:00 07/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 25 t0: [23:54:00 07/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [23:54:00 07/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [23:54:00 07/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [23:54:00 07/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [23:54:00 07/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [23:54:00 07/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [23:54:00 07/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [23:54:00 07/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [23:54:00 07/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [23:54:00 07/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [23:54:00 07/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [23:54:00 07/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.5 u1: L/min st: NotStopd t0: [23:54:00 07/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [23:54:00 07/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [23:54:00 07/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [23:54:00 07/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [23:54:00 07/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [23:54:00 07/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [23:54:00 07/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [23:54:00 07/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [23:54:00 07/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [23:54:00 07/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 511 u1: ml/B st: NotStopd t0: [23:54:00 07/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [23:54:00 07/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [23:54:00 07/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [23:54:00 07/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [23:54:00 07/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [23:54:00 07/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd
t0: [00:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [00:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [00:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [00:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [00:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [00:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [00:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 8 vu: ml t0: [00:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 135 vu: ml t0: [00:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [00:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 08/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 08/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 08/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 08/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 08/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 08/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [00:00:00 08/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 08/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 08/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 08/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 08/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 08/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 08/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 08/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 08/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 08/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 08/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [00:00:00 08/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 08/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 08/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 08/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 08/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 08/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 08/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 08/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 08/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 08/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 08/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 08/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 08/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 08/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 08/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 08/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 08/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 08/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 08/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 08/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 08/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [00:00:00 08/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 08/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Rectal Tube st: NotStopd t0: [00:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 08/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 08/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 08/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 08/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 08/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 08/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 08/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [00:00:00 08/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [00:00:00 08/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 08/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 08/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [01:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [01:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [01:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [01:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [01:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [01:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [01:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 8 vu: ml t0: [01:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [01:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [22:00:00 07/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [22:00:00 07/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [22:00:00 07/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd
t0: [01:16:00 08/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [01:16:00 08/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd
t0: [00:00:00 08/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [22:00:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.018 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 07/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.018 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 08/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.018 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 08/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.018 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [21:00:00 07/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [01:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd
t0: [02:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [02:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [02:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [02:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [02:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [02:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [03:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [03:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [03:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [03:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 08/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0115022 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:00:00 08/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.00920175 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [04:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [04:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [04:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [04:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [04:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [02:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 3.9123 vu: ml t0: [02:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [03:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [03:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [03:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2.5 vu: ml t0: [03:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 190 vu: ml t0: [03:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [04:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:30:00 08/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 1000 vu: ml
t0: [02:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [02:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [02:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [02:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [03:00:00 08/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [03:00:00 08/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 08/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 08/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:00:00 08/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [03:00:00 08/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:00:00 08/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 08/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 08/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 08/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 08/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 08/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [04:00:00 08/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 08/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 08/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 08/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 08/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd
t0: [04:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [04:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [04:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [04:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [04:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [03:56:00 08/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 33.3333 u1: ml/cmH st: NotStopd t0: [03:56:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [03:56:00 08/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 25 t0: [03:56:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [03:56:00 08/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [03:56:00 08/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [03:56:00 08/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [03:56:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [03:56:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [03:56:00 08/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [03:56:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [03:56:00 08/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [03:56:00 08/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [03:56:00 08/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [03:56:00 08/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.6 u1: L/min st: NotStopd t0: [03:56:00 08/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [03:56:00 08/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [03:56:00 08/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [03:56:00 08/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [03:56:00 08/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [03:56:00 08/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [03:56:00 08/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [03:56:00 08/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [03:56:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [03:56:00 08/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 481 u1: ml/B st: NotStopd t0: [03:56:00 08/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [03:56:00 08/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [03:56:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [03:56:00 08/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [05:00:00 08/05/2011] id: INV#1Chg o/Wire Date el: 0 cu: MICU cg: -1 st: D/C'd t0: [05:00:00 08/05/2011] id: INV Line#1 Site Date el: 0 cu: MICU cg: -1 st: D/C'd t0: [05:00:00 08/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: -1 st: D/C'd t0: [05:00:00 08/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: -1 st: D/C'd
t0: [04:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 08/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 08/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 08/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 08/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 08/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 08/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [04:00:00 08/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 08/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [04:00:00 08/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 08/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 08/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 08/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 08/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 08/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [04:00:00 08/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 08/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 08/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 08/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 08/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 08/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [04:00:00 08/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [04:00:00 08/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Rectal Tube st: NotStopd t0: [04:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 08/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 08/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 08/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 08/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 08/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 08/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 08/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [04:00:00 08/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [04:00:00 08/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 08/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [04:00:00 08/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [04:00:00 08/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 08/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 08/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [05:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [05:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [05:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [05:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [05:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [05:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [05:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [05:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 90 vu: ml t0: [05:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [04:00:00 08/05/2011] id: Levophed-k el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0.00920175 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped t0: [05:00:00 08/05/2011] 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: [05:00:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [05:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd
t0: [05:00:00 08/05/2011] id: INV Line#1 D/C Date el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [05:00:00 08/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [05:00:00 08/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [05:00:00 08/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: Infiltrated st: NotStopd t0: [05:00:00 08/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [05:00:00 08/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd
t0: [05:45:00 08/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 10.9 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 10.9 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 27 u1: % rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 8.9 u1: gm/dl rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 403 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.23 u1: /mic l rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 10.9 rs: Final st: NotStopd
t0: [06:00:00 08/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 106.383 u1: units st: NotStopd t0: [06:00:00 08/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 106.383 u1: units st: NotStopd t0: [06:00:00 08/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [06:00:00 08/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.376 u1: L st: NotStopd
t0: [05:45:00 08/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 35 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.1 u1: mg/dl rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 79 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 35 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.1 u1: mg/dl rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 79 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [05:45:00 08/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd
t0: [06:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [06:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [06:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [06:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [06:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [06:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [06:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [06:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [06:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [07:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [07:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [07:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [07:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [06:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [06:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [06:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [06:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [07:00:00 08/05/2011] 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 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [07:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd
t0: [06:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd
t0: [00:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 08/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 08/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [06:00:00 08/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [06:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [06:00:00 08/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd
t0: [07:00:00 08/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [07:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [07:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [07:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [07:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [07:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [07:00:00 08/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 10 vu: ml
t0: [07:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [07:00:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [07:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [07:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [07:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [07:00:00 08/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [07:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [08:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [08:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [08:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [08:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [08:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [08:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78.3333 u1: mmHg st: NotStopd t0: [08:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [08:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [08:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 08/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 1000 vu: ml
t0: [08:00:00 08/05/2011] 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: [07:00:00 09/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 8 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm tf: [07:00:00 09/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 8 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [08:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 08/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [08:00:00 08/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 08/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 08/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 08/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 08/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 08/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 08/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 08/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 08/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Fam Talked to RN st: NotStopd t0: [08:00:00 08/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [08:00:00 08/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 08/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [08:00:00 08/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 08/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 08/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 08/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 08/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [08:00:00 08/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 08/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 08/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 08/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 08/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 08/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 08/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 08/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 08/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 08/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 08/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 08/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [08:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 08/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 08/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 08/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 08/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 08/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 08/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 08/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [08:00:00 08/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Rectal Tube st: NotStopd t0: [08:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 08/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 08/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [08:00:00 08/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [08:00:00 08/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [08:00:00 08/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 08/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 08/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 08/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 08/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 08/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 08/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [08:00:00 08/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 08/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 08/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [08:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [08:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [08:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [08:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [08:15:00 08/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 26.3158 u1: ml/cmH st: NotStopd t0: [08:15:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:15:00 08/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [08:15:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [08:15:00 08/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:15:00 08/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [08:15:00 08/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [08:15:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:15:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:15:00 08/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [08:15:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:15:00 08/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [08:15:00 08/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [08:15:00 08/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [08:15:00 08/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.7 u1: L/min st: NotStopd t0: [08:15:00 08/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:15:00 08/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:15:00 08/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [08:15:00 08/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [08:15:00 08/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [08:15:00 08/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:15:00 08/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:15:00 08/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:15:00 08/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [08:15:00 08/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [08:15:00 08/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 535 u1: ml/B st: NotStopd t0: [08:15:00 08/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [08:15:00 08/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:15:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:15:00 08/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [05:45:00 08/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 29.3 rs: Final st: NotStopd
t0: [09:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [09:00:00 08/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [09:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [09:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [09:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [09:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [09:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [09:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [09:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [09:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [09:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [09:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 72.3333 u1: mmHg st: NotStopd t0: [09:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [09:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [09:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [09:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [09:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [09:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [09:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [09:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [09:00:00 08/05/2011] 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: [09:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [09:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [09:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [09:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [09:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [09:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [09:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [09:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [09:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [10:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [10:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [10:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 08/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [10:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [10:00:00 08/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [10:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [10:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 08/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [10:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [10:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 08/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [10:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 08/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [10:00:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [10:00:00 08/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [10:00:00 08/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [10:00:00 08/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 08/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [10:00:00 08/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 08/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [10:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 101 u1: BPM st: NotStopd t0: [10:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [10:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [10:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [10:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [10:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 08/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [10:00:00 08/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [10:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [10:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [10:00:00 08/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [10:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [10:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 08/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [10:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [10:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 08/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [10:00:00 08/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [10:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [10:00:00 08/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [10:00:00 08/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [10:00:00 08/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [10:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 08/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [10:00:00 08/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [10:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [10:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml
t0: [10:00:00 08/05/2011] 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 08/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 08/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [10:00:00 08/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 08/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [10:00:00 08/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [10:00:00 08/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 08/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 08/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [10:00:00 08/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd
t0: [10:15:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [10:15:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [10:15:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd
tf: [10:00:00 09/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [11:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [11:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 122 u1: BPM st: NotStopd t0: [11:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [11:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 71.6667 u1: mmHg st: NotStopd t0: [11:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [11:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [11:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 08/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 08/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 128 u1: BPM st: NotStopd t0: [12:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [12:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 75.6667 u1: mmHg st: NotStopd t0: [12:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [12:00:00 08/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 08/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [12:00:00 08/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [12:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [08:00:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [09:00:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [10:00:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [11:00:00 08/05/2011] 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: [11:00:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [12:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [11:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [11:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [11:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [11:00:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [11:00:00 08/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [11:00:00 08/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [11:00:00 08/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 08/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [11:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [11:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [11:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [11:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [11:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [11:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [11:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [11:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [11:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [11:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 08/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [11:00:00 08/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [11:00:00 08/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [11:00:00 08/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [11:00:00 08/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [11:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [11:00:00 08/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [11:00:00 08/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [11:00:00 08/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [11:00:00 08/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [11:00:00 08/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [11:00:00 08/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [11:00:00 08/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [11:00:00 08/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [12:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 08/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 08/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 08/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 08/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 08/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 08/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [12:00:00 08/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 08/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [12:00:00 08/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 08/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 08/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 08/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 08/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 08/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 08/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [12:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [12:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [12:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 08/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 08/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 08/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 08/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [12:00:00 08/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 08/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 08/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 08/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [12:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 08/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 08/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 08/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 08/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [12:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 08/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 08/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 08/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [12:00:00 08/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [12:00:00 08/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 08/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [12:00:00 08/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 08/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [12:00:00 08/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 08/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 08/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 08/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [12:00:00 08/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Straw st: NotStopd t0: [12:00:00 08/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 08/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 08/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [10:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [10:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [10:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [11:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [11:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [11:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [11:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [12:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [12:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [12:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [12:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [12:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 340 vu: ml t0: [12:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [12:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [13:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [13:00:00 08/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [13:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [13:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [13:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [13:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [13:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 132 u1: BPM st: NotStopd t0: [13:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [13:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [13:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [13:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [13:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [13:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [13:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [13:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [13:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [13:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [13:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [13:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [13:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [13:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 110 vu: ml t0: [13:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [13:00:00 08/05/2011] 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: [13:00:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [13:00:00 08/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 143 rs: Manual st: NotStopd
t0: [13:20:00 08/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 33.3333 u1: ml/cmH st: NotStopd t0: [13:20:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [13:20:00 08/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [13:20:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [13:20:00 08/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [13:20:00 08/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [13:20:00 08/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [13:20:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:20:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [13:20:00 08/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [13:20:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [13:20:00 08/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [13:20:00 08/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [13:20:00 08/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [13:20:00 08/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.8 u1: L/min st: NotStopd t0: [13:20:00 08/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [13:20:00 08/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [13:20:00 08/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [13:20:00 08/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [13:20:00 08/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [13:20:00 08/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [13:20:00 08/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [13:20:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 95 u1: % st: NotStopd t0: [13:20:00 08/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 522 u1: ml/B st: NotStopd t0: [13:20:00 08/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [13:20:00 08/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [13:20:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [13:20:00 08/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [13:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [13:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [13:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [13:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [13:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [13:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [13:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [13:00:00 08/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [14:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 08/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 08/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [14:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 08/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [14:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 08/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [14:00:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [14:00:00 08/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [14:00:00 08/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [14:00:00 08/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 08/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [14:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 130 u1: BPM st: NotStopd t0: [14:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [14:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [14:00:00 08/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [14:00:00 08/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [14:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [14:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 70.3333 u1: mmHg st: NotStopd t0: [14:00:00 08/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 08/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [14:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [14:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [14:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 08/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 08/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [14:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 08/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [14:00:00 08/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [14:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [14:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [14:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [14:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [14:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [14:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [14:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [14:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [14:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [14:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [14:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [14:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [14:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [15:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [15:00:00 08/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [15:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [15:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [15:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [15:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [15:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 124 u1: BPM st: NotStopd t0: [15:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [15:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [15:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [15:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [15:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.3333 u1: mmHg st: NotStopd t0: [15:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [15:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [15:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [15:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [15:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 08/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [15:00:00 08/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [15:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [15:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [15:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [15:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [15:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [15:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 140 vu: ml t0: [15:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [15:00:00 08/05/2011] 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: [15:00:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 50 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [16:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 08/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 08/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [16:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [16:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [16:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [16:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 65.3333 u1: mmHg st: NotStopd t0: [16:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 91 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [16:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [16:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [16:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [16:00:00 08/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [16:00:00 08/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [16:00:00 08/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [16:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [16:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [16:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [16:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 17.388 vu: ml t0: [16:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [16:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [16:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [16:00:00 08/05/2011] 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: [17:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [17:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [17:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 69.6667 u1: mmHg st: NotStopd t0: [17:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [17:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [17:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [17:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [17:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [17:00:00 08/05/2011] 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: [17:00:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [17:00:00 08/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 31.25 u1: ml/cmH st: NotStopd t0: [17:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [17:00:00 08/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [17:00:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 08/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [17:00:00 08/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [17:00:00 08/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [17:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 08/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [17:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [17:00:00 08/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [17:00:00 08/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [17:00:00 08/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [17:00:00 08/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.6 u1: L/min st: NotStopd t0: [17:00:00 08/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [17:00:00 08/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 08/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [17:00:00 08/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [17:00:00 08/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [17:00:00 08/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [17:00:00 08/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [17:00:00 08/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [17:00:00 08/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [17:00:00 08/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [17:00:00 08/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 539 u1: ml/B st: NotStopd t0: [17:00:00 08/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [17:00:00 08/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [17:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 08/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [17:00:00 08/05/2011] id: ETT Position Change el: 0 cu: MICU cg: RRT v1: Done st: NotStopd
tf: [14:00:00 09/05/2011] pt: IV Piggyback rt: IV fr: Q24H fs: 18 dn: 1 m1: Vancomycin HCl v1: 1000 u1: mg m2: Iso-Osmotic Dextrose v2: 200 u2: ml
t0: [18:00:00 08/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 162 rs: Manual st: NotStopd
t0: [18:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [18:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 136 u1: BPM st: NotStopd t0: [18:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [18:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [18:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 102 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [18:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [18:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [18:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [18:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [17:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [17:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [17:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml t0: [18:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [18:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [18:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [18:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [18:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [18:00:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [18:00:00 08/05/2011] 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 08/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: EKG st: NotStopd
t0: [18:00:00 08/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 90 vu: ml
t0: [23:00:00 08/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 100 ap: none
t0: [14:00:00 08/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [16:00:00 08/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [18:00:00 08/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml
t0: [18:30:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:30:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:30:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 127 u1: BPM st: NotStopd t0: [18:30:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [18:30:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.6667 u1: mmHg st: NotStopd t0: [18:30:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [18:30:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [18:30:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:30:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:30:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:30:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:31:00 08/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.43 rs: Final st: NotStopd t0: [18:31:00 08/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -3 rs: Final st: NotStopd t0: [18:31:00 08/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [18:31:00 08/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 29 u1: mmHg rs: Final st: NotStopd t0: [18:31:00 08/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 98 u1: mmHg rs: Final st: NotStopd t0: [18:31:00 08/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.43 rs: Final st: NotStopd
t0: [18:30:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 08/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [12:00:00 08/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [12:00:00 08/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 08/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 08/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 08/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [13:00:00 08/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [15:00:00 08/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [15:00:00 08/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 08/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 08/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 08/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 08/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 08/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [16:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 08/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 08/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 08/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 08/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 08/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 08/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 08/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 08/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 08/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 08/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 08/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 08/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 08/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 08/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 08/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 08/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 08/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 08/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [16:00:00 08/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 08/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [16:00:00 08/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 08/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [16:00:00 08/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [16:00:00 08/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 08/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [18:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [18:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [18:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [18:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [18:00:00 08/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [18:00:00 08/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [18:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [18:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [18:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [18:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 08/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [18:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [18:00:00 08/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [18:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [18:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [18:00:00 08/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [19:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [19:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 132 u1: BPM st: NotStopd t0: [19:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:00:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [19:00:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [19:00:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [19:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [19:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [19:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [19:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [19:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [19:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [19:00:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [19:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [19:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [19:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 8.694 vu: ml t0: [19:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [19:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [19:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [19:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:00:00 08/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 08/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 08/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 08/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 08/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 08/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 08/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 08/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 08/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 08/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 08/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 08/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [16:00:00 08/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 08/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 08/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 08/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [20:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 134 u1: BPM st: NotStopd t0: [20:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [20:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [20:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [20:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [20:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [20:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [20:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [20:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 180 vu: ml t0: [20:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [20:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [19:47:00 08/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 31.25 u1: ml/cmH st: NotStopd t0: [19:47:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [19:47:00 08/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [19:47:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [19:47:00 08/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [19:47:00 08/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [19:47:00 08/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [19:47:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [19:47:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [19:47:00 08/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [19:47:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [19:47:00 08/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [19:47:00 08/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [19:47:00 08/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [19:47:00 08/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.8 u1: L/min st: NotStopd t0: [19:47:00 08/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [19:47:00 08/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [19:47:00 08/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [19:47:00 08/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [19:47:00 08/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [19:47:00 08/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [19:47:00 08/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [19:47:00 08/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [19:47:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [19:47:00 08/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 522 u1: ml/B st: NotStopd t0: [19:47:00 08/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [19:47:00 08/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [19:47:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [19:47:00 08/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 08/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 08/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 08/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 08/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 08/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 08/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 08/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 08/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [20:00:00 08/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 08/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 08/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 08/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 08/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 08/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 08/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 08/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 08/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 08/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 08/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 08/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 08/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 08/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [20:00:00 08/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 08/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 08/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 08/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 08/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 08/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 08/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 08/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 08/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 08/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [20:00:00 08/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 08/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [20:00:00 08/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 08/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [20:00:00 08/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [20:00:00 08/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 08/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 08/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [18:20:00 08/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 38.6 rs: Final st: NotStopd
t0: [21:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 132 u1: BPM st: NotStopd t0: [21:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [21:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.3333 u1: mmHg st: NotStopd t0: [21:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [21:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [21:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [21:00:00 08/05/2011] id: Significant Events el: 0 cu: MICU cg: RN st: NotStopd t0: [21:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 08/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd
t0: [21:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 08/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 08/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd
t0: [21:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [21:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [21:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml t0: [21:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [21:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd
t0: [21:30:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:30:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:30:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:30:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:30:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:30:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:30:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 132 u1: BPM st: NotStopd t0: [21:30:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:30:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 113 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [21:30:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79.6667 u1: mmHg st: NotStopd t0: [21:30:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [21:30:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [21:30:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:30:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [21:30:00 08/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [21:30:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [21:30:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:30:00 08/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml
t0: [21:30:00 08/05/2011] 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: [21:30:00 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [10:00:00 09/05/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 12.5 u1: mg
t0: [22:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [22:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 133 u1: BPM st: NotStopd t0: [22:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 08/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [22:00:00 08/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.3333 u1: mmHg st: NotStopd t0: [22:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [22:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [22:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [22:00:00 08/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [22:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [22:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 08/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml t0: [22:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [22:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [22:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [22:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [22:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [22:00:00 08/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [22:00:00 08/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [22:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 08/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 08/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [22:00:00 08/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 08/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [22:00:00 08/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [22:00:00 08/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd
t0: [22:00:00 08/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 08/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 08/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 08/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [22:00:00 08/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [22:00:00 08/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 08/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 08/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 08/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 08/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 08/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 08/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 08/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [23:00:00 08/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 08/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [23:00:00 08/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 08/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [23:00:00 08/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 08/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 08/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 08/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 08/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 128 u1: BPM st: NotStopd t0: [23:00:00 08/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 08/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [23:00:00 08/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [23:00:00 08/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 08/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [23:00:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 08/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 08/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [23:00:00 08/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 08/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [23:00:00 08/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [23:00:00 08/05/2011] 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 08/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 08/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 25.9104 cv: 4311.93 ap: none t0: [23:00:00 08/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 85.9104 cv: 5751.93 ap: none t0: [23:00:00 08/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 1440 ap: none
t0: [23:00:00 08/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd t0: [23:00:00 08/05/2011] id: Significant Events el: 0 cu: MICU cg: RN st: NotStopd
t0: [23:45:00 08/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 31.25 u1: ml/cmH st: NotStopd t0: [23:45:00 08/05/2011] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [23:45:00 08/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [23:45:00 08/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [23:45:00 08/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [23:45:00 08/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [23:45:00 08/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [23:45:00 08/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [23:45:00 08/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [23:45:00 08/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [23:45:00 08/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [23:45:00 08/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [23:45:00 08/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [23:45:00 08/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [23:45:00 08/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [23:45:00 08/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.3 u1: L/min st: NotStopd t0: [23:45:00 08/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [23:45:00 08/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [23:45:00 08/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [23:45:00 08/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [23:45:00 08/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [23:45:00 08/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [23:45:00 08/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [23:45:00 08/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [23:45:00 08/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [23:45:00 08/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [23:45:00 08/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [23:45:00 08/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 545 u1: ml/B st: NotStopd t0: [23:45:00 08/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [23:45:00 08/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [23:45:00 08/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [23:45:00 08/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 09/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [00:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 117 u1: BPM st: NotStopd t0: [00:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [00:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [00:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [00:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [00:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 08/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [00:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [00:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [00:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [00:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [00:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 08/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 120 cv: 120 ap: none t0: [23:00:00 08/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -34.0896 cv: -34.0896 ap: none t0: [23:00:00 08/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 120 cv: 2255 ap: none t0: [23:00:00 08/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -34.0896 cv: 3396.93 ap: none t0: [23:00:00 08/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 120 cv: 2355 ap: none t0: [23:00:00 08/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -34.0896 cv: 17988 ap: carryForward
t0: [00:00:00 09/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 09/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 09/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 09/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 09/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 09/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 09/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 09/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 09/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 09/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 09/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 09/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 09/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 09/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 09/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 09/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [00:00:00 09/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 09/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 09/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 09/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 09/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 09/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 09/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 09/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 09/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 09/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 09/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [00:00:00 09/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 09/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 09/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [00:00:00 09/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 09/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 09/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 09/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 09/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Dozing Intermit st: NotStopd t0: [00:00:00 09/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 09/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 09/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 09/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 09/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:00:00 09/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 09/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 09/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 09/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 09/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 09/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 09/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 09/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 09/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 09/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 09/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 09/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 09/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [00:00:00 09/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 09/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 09/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 09/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 09/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [00:00:00 09/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 09/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 09/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 09/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 09/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 09/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 09/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 09/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 09/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [00:00:00 09/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 09/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [00:00:00 09/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 09/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [00:00:00 09/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [00:00:00 09/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 09/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 09/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [00:00:00 09/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [01:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 110 u1: BPM st: NotStopd t0: [01:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [01:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [01:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [01:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [01:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [02:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [02:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [02:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [02:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [02:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [01:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [01:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml t0: [01:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [02:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [02:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml t0: [02:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [01:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [02:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [02:00:00 09/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [02:00:00 09/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 09/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 09/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [02:00:00 09/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [02:00:00 09/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 09/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 09/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 09/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 09/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 09/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 09/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 09/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [03:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [03:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 09/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [03:00:00 09/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [03:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 97 u1: BPM st: NotStopd t0: [03:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 09/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [03:00:00 09/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [03:00:00 09/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [03:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [03:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [03:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [03:00:00 09/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [03:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [03:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [03:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 130 vu: ml t0: [03:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [03:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 09/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 09/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 185.91 cv: 185.91 ap: none t0: [23:00:00 09/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 125.91 cv: 1314.89 ap: none t0: [23:00:00 09/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 185.91 cv: 2984.89 ap: none t0: [23:00:00 09/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 1440 ap: none t0: [23:00:00 09/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 2905 ap: none t0: [23:00:00 09/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 185.91 cv: 9.89441 ap: carryForward t0: [23:00:00 09/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 2975 ap: carryForward t0: [23:00:00 09/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 185.91 cv: 17997.9 ap: carryForward
t0: [04:00:00 09/05/2011] id: Total PEEP Level el: 0 cu: MICU cg: -1 st: D/C'd
t0: [04:00:00 09/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 09/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 09/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 09/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 09/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 09/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 09/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 09/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 09/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 09/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 09/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 09/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 09/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 09/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [04:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 09/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [04:00:00 09/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 09/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 09/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 09/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 09/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 09/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 09/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 09/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 09/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 09/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 09/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 09/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 09/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 09/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 09/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 09/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [04:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [04:00:00 09/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 09/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 09/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 09/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [04:00:00 09/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 09/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 09/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 09/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 09/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [04:00:00 09/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [04:00:00 09/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [04:00:00 09/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 09/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 09/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 09/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 09/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 09/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 09/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [04:00:00 09/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [04:00:00 09/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 09/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 09/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [04:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [04:16:00 09/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 33.3333 u1: ml/cmH st: NotStopd t0: [04:16:00 09/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [04:16:00 09/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [04:16:00 09/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:16:00 09/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:16:00 09/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [04:16:00 09/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [04:16:00 09/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:16:00 09/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [04:16:00 09/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [04:16:00 09/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [04:16:00 09/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [04:16:00 09/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:16:00 09/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:16:00 09/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [04:16:00 09/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:16:00 09/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:16:00 09/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [04:16:00 09/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [04:16:00 09/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [04:16:00 09/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [04:16:00 09/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [04:16:00 09/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:16:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [04:16:00 09/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 509 u1: ml/B st: NotStopd t0: [04:16:00 09/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [04:16:00 09/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:16:00 09/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:16:00 09/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [05:48:00 09/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.4 rs: Final st: NotStopd t0: [05:48:00 09/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -3 rs: Final st: NotStopd t0: [05:48:00 09/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [05:48:00 09/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 32 u1: mmHg rs: Final st: NotStopd t0: [05:48:00 09/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 70 u1: mmHg rs: Final st: NotStopd t0: [05:48:00 09/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.4 rs: Final st: NotStopd
t0: [04:00:00 09/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 09/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [04:00:00 09/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [05:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [05:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [05:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [05:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [05:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [05:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 09/05/2011] 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: [05:00:00 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [04:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [04:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [04:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [04:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 75 vu: ml t0: [04:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [05:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [05:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [05:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 75 vu: ml t0: [05:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [06:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [06:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [06:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [06:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [06:00:00 09/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [06:00:00 09/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 09/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [06:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 09/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [06:00:00 09/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [06:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [06:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [06:00:00 09/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 09/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 09/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [06:00:00 09/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 09/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 09/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 09/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 09/05/2011] id: Significant Events el: 0 cu: MICU cg: RN st: NotStopd t0: [06:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [06:00:00 09/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [06:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [04:00:00 09/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 09/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 09/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 09/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 09/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 09/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 09/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [04:00:00 09/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [06:00:00 09/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [06:00:00 09/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [06:00:00 09/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 09/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [06:00:00 09/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd
t0: [04:00:00 09/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [06:00:00 09/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd
t0: [06:30:00 09/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.44 rs: Final st: NotStopd t0: [06:30:00 09/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -2 rs: Final st: NotStopd t0: [06:30:00 09/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [06:30:00 09/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 29 u1: mmHg rs: Final st: NotStopd t0: [06:30:00 09/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 95 u1: mmHg rs: Final st: NotStopd t0: [06:30:00 09/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.44 rs: Final st: NotStopd t0: [06:30:00 09/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 98 u1: % rs: Final st: NotStopd
t0: [06:00:00 09/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 137.652 u1: units st: NotStopd t0: [06:00:00 09/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 137.652 u1: units st: NotStopd t0: [06:00:00 09/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [06:00:00 09/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.247 u1: L st: NotStopd
t0: [06:30:00 09/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 10.6688 u1: ml/dl st: NotStopd t0: [06:37:00 09/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.6 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 9.6 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 24.2 u1: % rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 7.9 u1: gm/dl rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 404 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.9 u1: /mic l rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.6 rs: Final st: NotStopd
t0: [07:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [07:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 110 u1: BPM st: NotStopd t0: [07:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [07:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [07:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [07:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [07:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [07:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [07:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [07:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [07:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [07:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [00:00:00 09/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 145 rs: Manual st: NotStopd
t0: [06:00:00 09/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 30 vu: ml
t0: [06:37:00 09/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 31 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 6.9 u1: mg/dl rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 110 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 57 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 u1: mEq/L rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 31 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 6.9 u1: mg/dl rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 110 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 57 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 u1: mEq/L rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [06:37:00 09/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd
t0: [08:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: CoWork v1: 119 u1: BPM st: NotStopd t0: [08:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: CoWork v1: 144 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [08:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: CoWork v1: 27 u1: BPM st: NotStopd t0: [08:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: CoWork v1: 98 u1: % st: NotStopd t0: [08:00:00 09/05/2011] id: Temp. Site el: 0 cu: MICU cg: CoWork v1: Oral st: NotStopd t0: [08:00:00 09/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: CoWork v1: 37.1667 u1: Deg. C st: NotStopd t0: [08:00:00 09/05/2011] id: Temperature F el: 0 cu: MICU cg: CoWork v1: 98.9 u1: Deg. F st: NotStopd t0: [08:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: CoWork v1: 1 u1: kg st: NotStopd
t0: [08:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: CoWork vo: 167 vu: ml
t0: [08:00:00 09/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 09/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 09/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [08:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 09/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 09/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 09/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 09/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 09/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [08:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 09/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [08:00:00 09/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [08:00:00 09/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [08:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [08:00:00 09/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 60 vu: ml t0: [08:00:00 09/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 0 vu: ml t0: [08:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [08:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [09:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 119 u1: BPM st: NotStopd t0: [09:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 158 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [09:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [09:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [09:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [09:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 09/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [09:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [09:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [09:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [09:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [09:00:00 09/05/2011] 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: [09:00:00 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:00:00 09/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 09/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 09/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 09/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 09/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 09/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 09/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 09/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 09/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 09/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 09/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 09/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 09/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 09/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 09/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [09:00:00 09/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd
t0: [06:00:00 09/05/2011] id: Vancomycin/Trough Drug Level el: 0 cu: MICU cg: 1663 v1: 34.7 rs: Final st: NotStopd
t0: [08:00:00 09/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 09/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 09/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 09/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 09/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 09/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 09/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 09/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 09/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 09/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 09/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 09/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [08:00:00 09/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 09/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 09/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 09/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 09/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [08:00:00 09/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 09/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [09:00:00 09/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [09:00:00 09/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 09/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [09:00:00 09/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Fam Talked to RN st: NotStopd t0: [09:00:00 09/05/2011] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [09:00:00 09/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [09:00:00 09/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Hematoma st: NotStopd t0: [09:00:00 09/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [09:00:00 09/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serous v2: Scant st: NotStopd t0: [09:00:00 09/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 09/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [09:00:00 09/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Purple st: NotStopd t0: [09:00:00 09/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [09:00:00 09/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [09:00:00 09/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [09:00:00 09/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 09/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [09:00:00 09/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 09/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [09:00:00 09/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [09:00:00 09/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [09:00:00 09/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 09/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [09:00:00 09/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [09:00:00 09/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [09:00:00 09/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 09/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [09:00:00 09/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [09:00:00 09/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [09:00:00 09/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [09:00:00 09/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [09:00:00 09/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [09:00:00 09/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [09:00:00 09/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [09:30:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:30:00 09/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [09:30:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 122 u1: BPM st: NotStopd t0: [09:30:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:30:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [09:30:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [09:30:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:30:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [09:30:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [09:30:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 09/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [09:30:00 09/05/2011] 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: [09:30:00 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:27:00 09/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 20 u1: ml/cmH st: NotStopd t0: [09:27:00 09/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [09:27:00 09/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [09:27:00 09/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [09:27:00 09/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [09:27:00 09/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [09:27:00 09/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2 st: NotStopd t0: [09:27:00 09/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [09:27:00 09/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [09:27:00 09/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [09:27:00 09/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [09:27:00 09/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [09:27:00 09/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [09:27:00 09/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [09:27:00 09/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [09:27:00 09/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [09:27:00 09/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [09:27:00 09/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [09:27:00 09/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [09:27:00 09/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [09:27:00 09/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [09:27:00 09/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [09:27:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [09:27:00 09/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 510 u1: ml/B st: NotStopd t0: [09:27:00 09/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [09:27:00 09/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [09:27:00 09/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [09:27:00 09/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [10:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: CoWork v1: 120 u1: BPM st: NotStopd t0: [10:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: CoWork v1: 154 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [10:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: CoWork v1: 25 u1: BPM st: NotStopd t0: [10:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: CoWork v1: 100 u1: % st: NotStopd t0: [10:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: CoWork v1: 1 u1: kg st: NotStopd
t0: [10:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: CoWork vo: 250 vu: ml
t0: [10:00:00 09/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [10:00:00 09/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thin st: NotStopd t0: [10:00:00 09/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd
tf: [09:00:00 10/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 10 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm tf: [09:00:00 10/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 10 dn: 1 m1: Potassium Chloride v1: 20 u1: mEq
t0: [10:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [10:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd
t0: [10:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [10:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [10:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [10:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 50 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [10:00:00 09/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [10:00:00 09/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 09/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [10:00:00 09/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 09/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [10:00:00 09/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [10:00:00 09/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [10:00:00 09/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [10:00:00 09/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [10:00:00 09/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [10:00:00 09/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [10:00:00 09/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 09/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [10:00:00 09/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [10:00:00 09/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [10:00:00 09/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [10:00:00 09/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [10:00:00 09/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 09/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [10:00:00 09/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [10:00:00 09/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [10:00:00 09/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [10:00:00 09/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 09/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [10:00:00 09/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 09/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 09/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 09/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [10:00:00 09/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 09/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 09/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 09/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 09/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [10:00:00 09/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [10:00:00 09/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [10:00:00 09/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [10:00:00 09/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 09/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [10:00:00 09/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [10:00:00 09/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [10:00:00 09/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [10:00:00 09/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Changed st: NotStopd t0: [10:00:00 09/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [10:00:00 09/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [10:40:00 09/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [10:45:00 09/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd
tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: Q4-6H:PRN m1: Oxycodone v1: 5 u1: mg
t0: [11:00:00 09/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [11:00:00 09/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [11:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 09/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [11:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 133 u1: BPM st: NotStopd t0: [11:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [11:00:00 09/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [11:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [11:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [11:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [11:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 09/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [11:00:00 09/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [11:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 17.388 vu: ml t0: [11:00:00 09/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 120 vu: ml t0: [11:00:00 09/05/2011] tf: [15:00:00 09/05/2011] dt: 240 id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [11:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [11:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [11:00:00 09/05/2011] 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: [11:00:00 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 50 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [11:31:00 09/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.42 rs: Final st: NotStopd t0: [11:31:00 09/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: no data rs: Final st: NotStopd t0: [11:31:00 09/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: no data rs: Final st: NotStopd t0: [11:31:00 09/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 u1: mmHg rs: Final st: NotStopd t0: [11:31:00 09/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 u1: mmHg rs: Final st: NotStopd t0: [11:31:00 09/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.42 rs: Final st: NotStopd t0: [11:31:00 09/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.11 rs: Final st: NotStopd
t0: [08:00:00 09/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 09/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 09/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [08:00:00 09/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 09/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 09/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 09/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 09/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 09/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 09/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 09/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 09/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 09/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 09/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 09/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 09/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 09/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 09/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 09/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 09/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [08:00:00 09/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [10:00:00 09/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 09/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 09/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 09/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 09/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 09/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 09/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [10:00:00 09/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 09/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 09/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [10:00:00 09/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [10:00:00 09/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 09/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [11:00:00 09/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [12:00:00 09/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 09/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 09/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [12:00:00 09/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 09/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 09/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 09/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 09/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 09/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 09/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 09/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 09/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 09/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 09/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [12:00:00 09/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 09/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 09/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 09/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [12:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 09/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [12:00:00 09/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 09/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 09/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 09/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [12:00:00 09/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 09/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 09/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 09/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 09/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 09/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 09/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN st: NotStopd t0: [12:00:00 09/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Hematoma st: NotStopd t0: [12:00:00 09/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [12:00:00 09/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serous v2: Scant st: NotStopd t0: [12:00:00 09/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 09/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [12:00:00 09/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Purple st: NotStopd t0: [12:00:00 09/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [12:00:00 09/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 09/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 09/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 09/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 09/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 09/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 09/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 09/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 09/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [12:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [12:00:00 09/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [12:00:00 09/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 09/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 09/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 09/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 09/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 09/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 09/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 09/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [12:00:00 09/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 09/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 09/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 09/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 09/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 09/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [12:00:00 09/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 09/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 09/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [12:00:00 09/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 09/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 09/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [12:00:00 09/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [12:00:00 09/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 09/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 09/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 09/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 09/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [12:00:00 09/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [12:00:00 09/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 09/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 09/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [12:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [12:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [12:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 17.388 vu: ml t0: [12:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml t0: [12:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [12:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 50 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 09/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 09/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [12:00:00 09/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd
t0: [12:00:00 09/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 114 rs: Manual st: NotStopd
t0: [11:15:00 09/05/2011] id: LDH Enzymes el: 0 cu: MICU cg: 1663 v1: 214 rs: Final st: NotStopd
t0: [12:00:00 09/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [13:00:00 09/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [13:00:00 09/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [13:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 09/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [13:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [13:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 09/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [13:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 09/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 98 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [13:00:00 09/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [13:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [13:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [13:00:00 09/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [13:00:00 09/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [13:00:00 09/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [13:00:00 09/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 09/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Medium t0: [13:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [13:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [13:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 17.388 vu: ml t0: [13:00:00 09/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Medium t0: [13:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml t0: [13:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [13:00:00 09/05/2011] 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 09/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [13:00:00 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [13:06:00 09/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 27.7778 u1: ml/cmH st: NotStopd t0: [13:06:00 09/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [13:06:00 09/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [13:06:00 09/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [13:06:00 09/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [13:06:00 09/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [13:06:00 09/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2 st: NotStopd t0: [13:06:00 09/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:06:00 09/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [13:06:00 09/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [13:06:00 09/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [13:06:00 09/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [13:06:00 09/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [13:06:00 09/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [13:06:00 09/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [13:06:00 09/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [13:06:00 09/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [13:06:00 09/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [13:06:00 09/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [13:06:00 09/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [13:06:00 09/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [13:06:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [13:06:00 09/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [13:06:00 09/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [13:06:00 09/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [13:06:00 09/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [13:06:00 09/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [14:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: CoWork v1: 87 u1: BPM st: NotStopd t0: [14:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: CoWork v1: 99 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [14:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: CoWork v1: 24 u1: BPM st: NotStopd t0: [14:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: CoWork v1: 97 u1: % st: NotStopd t0: [14:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: CoWork v1: 1 u1: kg st: NotStopd
t0: [14:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: CoWork vo: 248 vu: ml
t0: [14:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [14:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [14:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd
t0: [14:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [14:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [14:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [14:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:00:00 09/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 09/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 09/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 09/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 09/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 09/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 09/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 09/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 09/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [14:00:00 09/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 09/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 09/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [15:00:00 09/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [15:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 09/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [15:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [15:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 97 u1: BPM st: NotStopd t0: [15:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 09/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [15:00:00 09/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [15:00:00 09/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [15:00:00 09/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [15:00:00 09/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [15:00:00 09/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [15:00:00 09/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [15:00:00 09/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [15:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 93 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [15:00:00 09/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [15:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [15:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [15:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 09/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [14:00:00 09/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 09/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 50 vu: ml t0: [15:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [15:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [15:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [15:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [15:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [15:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 09/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 230 ap: none
t0: [10:00:00 09/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [12:00:00 09/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 09/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 09/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 09/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 09/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 09/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 09/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 09/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 09/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 09/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 09/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 09/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 09/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 09/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [16:00:00 09/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [16:00:00 09/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 09/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 09/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 09/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 09/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [16:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 09/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 09/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 09/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 09/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 09/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Hematoma st: NotStopd t0: [16:00:00 09/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [16:00:00 09/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serous v2: Scant st: NotStopd t0: [16:00:00 09/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 09/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [16:00:00 09/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Purple st: NotStopd t0: [16:00:00 09/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [16:00:00 09/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 09/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 09/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 09/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 09/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 09/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 09/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 09/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 09/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [16:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [16:00:00 09/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [16:00:00 09/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 09/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 09/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 09/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 09/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 09/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 09/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 09/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [16:00:00 09/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 09/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 09/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 09/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 09/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 09/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [16:00:00 09/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 09/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 09/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [16:00:00 09/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 09/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 09/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [16:00:00 09/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 09/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [16:00:00 09/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 09/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 09/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 09/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 09/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [16:00:00 09/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [16:00:00 09/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 09/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 09/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [16:00:00 09/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [16:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [16:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [16:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [16:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [16:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [16:00:00 09/05/2011] 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: [16:00:00 11/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Captopril v1: 6.25 u1: mg tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Calcium Carbonate v1: 500 u1: mg
t0: [16:00:00 09/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [16:00:00 09/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd
t0: [16:00:00 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [16:00:00 09/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 24.8 u1: % rs: Final st: NotStopd
t0: [16:42:00 09/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:42:00 09/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [16:42:00 09/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:42:00 09/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [16:42:00 09/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [16:42:00 09/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:42:00 09/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [16:42:00 09/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:42:00 09/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:42:00 09/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [16:42:00 09/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [16:42:00 09/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [16:42:00 09/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:42:00 09/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:42:00 09/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 15 u1: . st: NotStopd t0: [16:42:00 09/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 21 u1: BPM st: NotStopd t0: [16:42:00 09/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [16:42:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [16:42:00 09/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 480 u1: ml/B st: NotStopd t0: [16:42:00 09/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:42:00 09/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:42:00 09/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [17:00:00 09/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [17:00:00 09/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [17:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 09/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [17:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 117 u1: BPM st: NotStopd t0: [17:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [17:00:00 09/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [17:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [17:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [17:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [17:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [17:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.9552 vu: ml t0: [17:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [17:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [17:00:00 09/05/2011] 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: [17:00:00 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [18:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 09/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 120 u1: BPM st: NotStopd t0: [18:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:00:00 09/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [18:00:00 09/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 09/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [18:00:00 09/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [18:00:00 09/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [18:00:00 09/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [18:00:00 09/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [18:00:00 09/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [18:00:00 09/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 09/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 09/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [18:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [18:00:00 09/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [18:00:00 09/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:00:00 09/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [18:00:00 09/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [18:00:00 09/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 09/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [18:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [18:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [18:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [18:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml
t0: [19:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 122 u1: BPM st: NotStopd t0: [19:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [19:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [19:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [19:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [19:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [19:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10.4328 vu: ml t0: [19:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [19:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [19:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [19:00:00 09/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 108 rs: Manual st: NotStopd
t0: [19:02:00 09/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [19:02:00 09/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 10.706 u1: ml/dl st: NotStopd t0: [19:02:00 09/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -4 rs: Final st: NotStopd t0: [19:02:00 09/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [19:02:00 09/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 35 u1: mmHg rs: Final st: NotStopd t0: [19:02:00 09/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 107 u1: mmHg rs: Final st: NotStopd t0: [19:02:00 09/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [19:02:00 09/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.09 rs: Final st: NotStopd t0: [19:02:00 09/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 98 u1: % rs: Final st: NotStopd
t0: [18:30:00 09/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [18:30:00 09/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd t0: [18:30:00 09/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [18:30:00 09/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd t0: [19:10:00 09/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [19:10:00 09/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd
t0: [15:00:00 09/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 0 vu: ml
t0: [23:00:00 09/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 70 ap: none
tf: [19:00:00 10/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 20 dn: 1 m1: Calcium Gluconate v1: 2 u1: gm tf: [19:00:00 10/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 20 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [20:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [20:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 91 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [20:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [20:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [20:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [20:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:04:00 09/05/2011] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [20:04:00 09/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:04:00 09/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [20:04:00 09/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:04:00 09/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:04:00 09/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:04:00 09/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:04:00 09/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [20:04:00 09/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [20:04:00 09/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:04:00 09/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [20:04:00 09/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:04:00 09/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:04:00 09/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [20:04:00 09/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:04:00 09/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:04:00 09/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 15 u1: . st: NotStopd t0: [20:04:00 09/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 21 u1: BPM st: NotStopd t0: [20:04:00 09/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:04:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [20:04:00 09/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 434 u1: ml/B st: NotStopd t0: [20:04:00 09/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:04:00 09/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:04:00 09/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:30:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:30:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:30:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:30:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:30:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [20:30:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 88 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [20:30:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [20:30:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:30:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [20:30:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [20:30:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:30:00 09/05/2011] 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: [20:30:00 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [20:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:30:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:30:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:30:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd
t0: [20:00:00 09/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 09/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 09/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 09/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 09/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 09/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 09/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 09/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 09/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 09/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 09/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 09/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 09/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 09/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 09/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [20:00:00 09/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 09/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 09/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 09/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 09/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 09/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [20:00:00 09/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 09/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 09/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [20:00:00 09/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 09/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 09/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [20:00:00 09/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 09/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 09/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 09/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 09/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 09/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 09/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 09/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 09/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 09/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 09/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 09/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 09/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 09/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 09/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 09/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 09/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [20:00:00 09/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 09/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 09/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 09/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [20:00:00 09/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 09/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 09/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 09/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 09/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 09/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 09/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 09/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 09/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 09/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [20:00:00 09/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 09/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [20:00:00 09/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [20:00:00 09/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 09/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 09/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [20:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [20:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [20:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 260 vu: ml t0: [20:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [20:30:00 09/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [21:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [21:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [21:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [21:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [21:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [21:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [21:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 12.1716 vu: ml t0: [21:00:00 09/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [21:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [21:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [21:30:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:30:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:30:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:30:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:30:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:30:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:30:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [21:30:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:30:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [21:30:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [21:30:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:30:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [21:30:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:30:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 09/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [22:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 120 u1: BPM st: NotStopd t0: [22:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [22:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [22:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [22:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:30:00 09/05/2011] 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: [21:30:00 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [22:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [22:00:00 09/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [22:00:00 09/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [22:00:00 09/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [22:00:00 09/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [22:00:00 09/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [22:00:00 09/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [22:00:00 09/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [22:00:00 09/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [22:00:00 09/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [22:00:00 09/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd
t0: [22:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [22:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 12.1716 vu: ml t0: [22:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
tf: [06:00:00 10/05/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 25 u1: mg
t0: [23:00:00 09/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 09/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 09/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 09/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 09/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 09/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 09/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 120 u1: BPM st: NotStopd t0: [23:00:00 09/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 09/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [23:00:00 09/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [23:00:00 09/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 09/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [23:00:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 09/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 09/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [23:00:00 09/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 09/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [23:00:00 09/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [23:00:00 09/05/2011] 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 09/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:29:00 09/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [23:29:00 09/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [23:29:00 09/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [23:29:00 09/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [23:29:00 09/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [23:29:00 09/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [23:29:00 09/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [23:29:00 09/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [23:29:00 09/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [23:29:00 09/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [23:29:00 09/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [23:29:00 09/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [23:29:00 09/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.9 u1: L/min st: NotStopd t0: [23:29:00 09/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [23:29:00 09/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [23:29:00 09/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 15 u1: . st: NotStopd t0: [23:29:00 09/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [23:29:00 09/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [23:29:00 09/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [23:29:00 09/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [23:29:00 09/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [23:29:00 09/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 530 u1: ml/B st: NotStopd t0: [23:29:00 09/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [23:29:00 09/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 119 u1: BPM st: NotStopd t0: [00:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [00:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [00:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [00:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [00:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 09/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [00:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [00:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [00:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml t0: [00:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [00:00:00 10/05/2011] 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 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 10/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: 1663 cv: 100 ap: none
t0: [00:00:00 10/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [00:30:00 10/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [00:30:00 10/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd
t0: [01:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 110 u1: BPM st: NotStopd t0: [01:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [01:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [01:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [01:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [02:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [02:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [02:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [02:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [01:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [01:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 110 vu: ml t0: [01:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [02:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [02:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [02:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [03:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [03:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [03:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 110 vu: ml t0: [03:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [01:00:00 10/05/2011] 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 10/05/2011] 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 10/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 200 cv: 200 ap: none t0: [23:00:00 10/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -51 cv: -51 ap: none t0: [23:00:00 10/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 29 cv: 2065.17 ap: none t0: [23:00:00 10/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 149 cv: 2905.17 ap: none t0: [23:00:00 10/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 120 cv: 840 ap: none t0: [23:00:00 10/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 200 cv: 3100 ap: none t0: [23:00:00 10/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -51 cv: -294.831 ap: none t0: [23:00:00 10/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 200 cv: 3200 ap: none t0: [23:00:00 10/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -51 cv: 17703.1 ap: carryForward
t0: [01:00:00 10/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [01:00:00 10/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 10/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [01:00:00 10/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [01:00:00 10/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [01:00:00 10/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [01:00:00 10/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [01:00:00 10/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [01:00:00 10/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [01:00:00 10/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [01:00:00 10/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [01:00:00 10/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [01:00:00 10/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 10/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [01:00:00 10/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [01:00:00 10/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [01:00:00 10/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [01:00:00 10/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 10/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [01:00:00 10/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 10/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [01:00:00 10/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [01:00:00 10/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [01:00:00 10/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [01:00:00 10/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [01:00:00 10/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [01:00:00 10/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [01:00:00 10/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [01:00:00 10/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [01:00:00 10/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 10/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 10/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [01:00:00 10/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [01:00:00 10/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [01:00:00 10/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 10/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [01:00:00 10/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [01:00:00 10/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [01:00:00 10/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [01:00:00 10/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [01:00:00 10/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [01:00:00 10/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [01:00:00 10/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [01:00:00 10/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [01:00:00 10/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [01:00:00 10/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [01:00:00 10/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [01:00:00 10/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [01:00:00 10/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [01:00:00 10/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [01:00:00 10/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [01:00:00 10/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [01:00:00 10/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [01:00:00 10/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [01:00:00 10/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [01:00:00 10/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [01:00:00 10/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [01:00:00 10/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [01:00:00 10/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [01:00:00 10/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [01:00:00 10/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [01:00:00 10/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [01:00:00 10/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [01:00:00 10/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [02:00:00 10/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [02:00:00 10/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [02:00:00 10/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [02:00:00 10/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [02:00:00 10/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [02:00:00 10/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [02:00:00 10/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [02:00:00 10/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [02:00:00 10/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [02:00:00 10/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd
t0: [03:00:00 10/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: -1 st: D/C'd
t0: [03:30:00 10/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [03:30:00 10/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [03:30:00 10/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [03:30:00 10/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [03:30:00 10/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [03:30:00 10/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [03:30:00 10/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [03:30:00 10/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [03:30:00 10/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [03:30:00 10/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [03:30:00 10/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [03:30:00 10/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [03:30:00 10/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [03:30:00 10/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [03:30:00 10/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [03:30:00 10/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 15 u1: . st: NotStopd t0: [03:30:00 10/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 17 u1: BPM st: NotStopd t0: [03:30:00 10/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [03:30:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [03:30:00 10/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 591 u1: ml/B st: NotStopd t0: [03:30:00 10/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [03:30:00 10/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [02:00:00 10/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [03:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [03:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [03:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [03:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [03:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [03:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 10/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 10/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 10/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 10/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 10/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 10/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 10/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 10/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 10/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 10/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 10/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 10/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 10/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 10/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 10/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 10/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 10/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [04:00:00 10/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 10/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 10/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 10/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [04:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 10/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 10/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 10/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [04:00:00 10/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 10/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 10/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [04:00:00 10/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 10/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 10/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [04:00:00 10/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 10/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 10/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [04:00:00 10/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 10/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [04:00:00 10/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 10/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 10/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 10/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [04:00:00 10/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 10/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 10/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 10/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 10/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [04:00:00 10/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 10/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 10/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [04:00:00 10/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [04:00:00 10/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 10/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 10/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [04:00:00 10/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 10/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 10/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 10/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 10/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 10/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 10/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 10/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [04:00:00 10/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [04:00:00 10/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [04:00:00 10/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 10/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [04:00:00 10/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [04:00:00 10/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 10/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 10/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [04:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [04:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [04:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [04:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [03:00:00 10/05/2011] 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 10/05/2011] 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: [03:55:00 10/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd t0: [03:55:00 10/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 89 rs: Final st: NotStopd t0: [03:55:00 10/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -1 rs: Final st: NotStopd t0: [03:55:00 10/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [03:55:00 10/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 34 u1: mmHg rs: Final st: NotStopd t0: [03:55:00 10/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 105 u1: mmHg rs: Final st: NotStopd t0: [03:55:00 10/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd t0: [03:55:00 10/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 89 rs: Final st: NotStopd t0: [03:55:00 10/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 97 u1: % rs: Final st: NotStopd
t0: [03:55:00 10/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.11 rs: Final st: NotStopd
t0: [04:00:00 10/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 10/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [04:00:00 10/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd
t0: [04:25:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:25:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:25:00 10/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [04:25:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:25:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: Frequent st: NotStopd t0: [04:25:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: PVC's st: NotStopd t0: [04:25:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:25:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 132 u1: BPM st: NotStopd t0: [04:25:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:25:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 162 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [04:25:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [04:25:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:25:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [04:25:00 10/05/2011] id: Significant Events el: 0 cu: MICU cg: RN st: NotStopd t0: [04:25:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [04:25:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:30:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:30:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:30:00 10/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [04:30:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:30:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: Frequent st: NotStopd t0: [04:30:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: PVC's st: NotStopd t0: [04:30:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:30:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 120 u1: BPM st: NotStopd t0: [04:30:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:30:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [04:30:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [04:30:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:30:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [04:30:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:30:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:25:00 10/05/2011] 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: [04:25:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [04:30:00 10/05/2011] 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 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 140 vu: ml
t0: [05:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [05:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [05:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [05:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [05:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [05:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.9104 vu: ml t0: [05:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [05:00:00 10/05/2011] 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 09/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [23:00:00 09/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [23:00:00 09/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [23:00:00 09/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [23:00:00 09/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [23:00:00 09/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [23:00:00 09/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [23:00:00 09/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [03:00:00 10/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [03:00:00 10/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 10/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 10/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:00:00 10/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [03:00:00 10/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:00:00 10/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [03:00:00 10/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 10/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 10/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 10/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 10/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [06:00:00 10/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [06:00:00 10/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 10/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 10/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [06:00:00 10/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [06:00:00 10/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 10/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 10/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 10/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 10/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 10/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 10/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 10/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd
t0: [06:00:00 10/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [06:00:00 10/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [06:00:00 10/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [06:00:00 10/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [06:00:00 10/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [06:00:00 10/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [06:00:00 10/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [06:00:00 10/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [06:00:00 10/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [06:00:00 10/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd
t0: [01:00:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [02:00:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:00:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [04:00:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [04:15:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [04:30:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [05:00:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:40:00 10/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 10.3 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 27 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.6 u1: mg/dl rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 86 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 10.3 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 27 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.6 u1: mg/dl rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 86 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 24.2 u1: % rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 8.1 u1: gm/dl rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 413 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.85 u1: /mic l rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 10.3 rs: Final st: NotStopd t0: [03:55:00 10/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 10.8539 u1: ml/dl st: NotStopd
t0: [06:00:00 10/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 137.931 u1: units st: NotStopd t0: [06:00:00 10/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 137.931 u1: units st: NotStopd t0: [06:00:00 10/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [06:00:00 10/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.232 u1: L st: NotStopd
t0: [06:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 122 u1: BPM st: NotStopd t0: [06:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [06:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [06:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [06:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 10/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [07:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [07:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [07:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [07:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [07:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [07:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [06:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [06:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15.6492 vu: ml t0: [06:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [06:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [07:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [07:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [07:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15.6492 vu: ml t0: [07:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [06:00:00 10/05/2011] 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 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [07:00:00 10/05/2011] 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 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [07:00:00 10/05/2011] id: Significant Events el: 0 cu: MICU cg: RN st: NotStopd
t0: [08:00:00 10/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 10/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 10/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 10/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 10/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 10/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 10/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 10/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 10/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 10/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 10/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 10/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 10/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 10/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 10/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 10/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 10/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [08:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 10/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [08:00:00 10/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 10/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 10/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 10/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 10/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 10/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 10/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 10/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 10/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 10/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 10/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [08:00:00 10/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 10/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 10/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 10/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 10/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [08:00:00 10/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 10/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 10/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [08:00:00 10/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 10/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [08:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 10/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 10/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 10/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 10/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [08:00:00 10/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 10/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 10/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 10/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 10/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 10/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 10/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [08:00:00 10/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 10/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 10/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.7778 u1: Deg. C st: NotStopd t0: [08:00:00 10/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 101.8 u1: Deg. F st: NotStopd t0: [08:00:00 10/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:00:00 10/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 10/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 10/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 10/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 10/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 10/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Purulent st: NotStopd t0: [08:00:00 10/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 10/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 10/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [08:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15.6492 vu: ml t0: [08:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [08:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [08:00:00 10/05/2011] 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 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:40:00 10/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 17.7 rs: Final st: NotStopd
t0: [09:00:00 10/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [09:00:00 10/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [09:00:00 10/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [09:00:00 10/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [09:00:00 10/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [09:00:00 10/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [09:00:00 10/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [09:00:00 10/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [09:00:00 10/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [09:00:00 10/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [09:00:00 10/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [09:00:00 10/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [09:00:00 10/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.9 u1: L/min st: NotStopd t0: [09:00:00 10/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [09:00:00 10/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [09:00:00 10/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 18 u1: . st: NotStopd t0: [09:00:00 10/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [09:00:00 10/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [09:00:00 10/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [09:00:00 10/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 620 u1: ml/B st: NotStopd t0: [09:00:00 10/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [09:00:00 10/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [09:00:00 10/05/2011] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd t0: [09:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 93 u1: % st: NotStopd
t0: [09:00:00 10/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd
t0: [08:00:00 10/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Pan Cultured st: NotStopd
t0: [09:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [09:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15.6492 vu: ml t0: [09:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [09:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
tf: [10:00:00 10/05/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 37.5 u1: mg
t0: [08:00:00 10/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [08:00:00 10/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [09:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [09:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [09:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [09:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [09:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 120 u1: BPM st: NotStopd t0: [10:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [10:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [10:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [10:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [10:00:00 10/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [10:00:00 10/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [10:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 10/05/2011] 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: [09:00:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [10:00:00 10/05/2011] 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 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [10:00:00 10/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [10:00:00 10/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [10:00:00 10/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [10:00:00 10/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [10:00:00 10/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Lethargic st: NotStopd t0: [10:00:00 10/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [10:00:00 10/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [10:00:00 10/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd
t0: [10:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15.6492 vu: ml t0: [10:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml t0: [10:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [10:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml st: Stopped
t0: [06:45:00 10/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 17.6 rs: Final st: NotStopd
tf: [10:00:00 11/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 11 dn: 1 m1: Vancomycin HCl v1: 1000 u1: mg m2: Iso-Osmotic Dextrose v2: 200 u2: ml
t0: [11:00:00 10/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 10/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [11:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 10/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 10/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/O2 Issues st: NotStopd t0: [11:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [11:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 93 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [11:00:00 10/05/2011] id: Pain Management el: 1 cu: MICU cg: RN v1: PO Med v2: Repositioned st: NotStopd t0: [11:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [11:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [11:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [11:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 10/05/2011] 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: [11:00:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [11:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15.6492 vu: ml t0: [11:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [11:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [08:00:00 10/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 10/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 10/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 10/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [08:00:00 10/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [08:00:00 10/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 10/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [08:00:00 10/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 10/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 10/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 10/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 10/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 10/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 10/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 10/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 10/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 10/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [10:00:00 10/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [10:00:00 10/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [10:00:00 10/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 10/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [10:00:00 10/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [10:00:00 10/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 10/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 10/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [10:00:00 10/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 10/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 10/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 10/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 10/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd
t0: [10:00:00 10/05/2011] id: Temperature F el: 0 cu: MICU cg: RN u1: Deg. F st: NotStopd t0: [12:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [12:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 79 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [12:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 58 u1: mmHg st: NotStopd t0: [12:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [12:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [12:00:00 10/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.2778 u1: Deg. C st: NotStopd t0: [12:00:00 10/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.9 u1: Deg. F st: NotStopd t0: [12:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 10/05/2011] 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 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 15 u1: mmHg st: NotStopd
t0: [12:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [12:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15.6492 vu: ml t0: [12:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [12:00:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 24 u1: mmHg st: NotStopd t0: [12:15:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:15:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [12:15:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:15:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:15:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:15:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:15:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:15:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [12:15:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:15:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 83 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [12:15:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [12:15:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:15:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [12:15:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [12:15:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:15:00 10/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 250 vu: ml t0: [12:15:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 2.5 vu: ml t0: [12:15:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 3.9123 vu: ml st: Stopped t0: [12:15:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 0.5 vu: ml
t0: [12:15:00 10/05/2011] 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 10/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 137 rs: Manual st: NotStopd
t0: [11:30:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:30:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:30:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [11:30:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 92 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [11:30:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [11:30:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:30:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [11:30:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [11:30:00 10/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [11:30:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:45:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:45:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 33 u1: mmHg st: NotStopd t0: [11:45:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:45:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:45:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:45:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [11:45:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 86 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [11:45:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [11:45:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:45:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [11:45:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [11:45:00 10/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [11:45:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:05:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:05:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [12:05:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:05:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:05:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:05:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 123 u1: BPM st: NotStopd t0: [12:05:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [12:05:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [12:05:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:05:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [12:05:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [12:05:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:30:00 10/05/2011] 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: [12:15:00 10/05/2011] tf: [14:07:00 24/05/2011] dt: 20272 id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [11:45:00 10/05/2011] 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: [11:45:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 v1: 45 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [12:00:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 du: mcgkgmin sv: 50 su: vl rt: IV Drip st: Stopped t0: [12:05:00 10/05/2011] 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: [12:15:00 10/05/2011] id: Propofol el: 1 cu: MICU cg: RN so: N/A vo: 0 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:05:00 10/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [12:05:00 10/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd
t0: [12:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml
t0: [12:00:00 10/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 10/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [12:00:00 10/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 10/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:00:00 10/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [12:00:00 10/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 10/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 10/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [12:00:00 10/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:00:00 10/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Combivent st: NotStopd t0: [12:00:00 10/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:00:00 10/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.5 u1: L/min st: NotStopd t0: [12:00:00 10/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 10/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 15 u1: . st: NotStopd t0: [12:00:00 10/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [12:00:00 10/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [12:00:00 10/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 525 u1: ml/B st: NotStopd t0: [12:00:00 10/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:00:00 10/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: Q4-6H:PRN m1: Acetaminophen v1: 325-650 u1: mg
t0: [12:30:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:30:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [12:30:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:30:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:30:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:30:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 133 u1: BPM st: NotStopd t0: [12:30:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:30:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [12:30:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [12:30:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:30:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [12:30:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [12:30:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:30:00 10/05/2011] 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: [13:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [13:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 123 u1: BPM st: NotStopd t0: [13:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 93 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [13:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [13:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [13:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [13:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:05:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:05:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [13:05:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:05:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:05:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:05:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 116 u1: BPM st: NotStopd t0: [13:05:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 76 u1: mmHg v2: 42 u2: mmHg st: NotStopd t0: [13:05:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 55 u1: mmHg st: NotStopd t0: [13:05:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:05:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [13:05:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [13:05:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:10:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:10:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [13:10:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:10:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:10:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:10:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 114 u1: BPM st: NotStopd t0: [13:10:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 86 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [13:10:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [13:10:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:10:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [13:10:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [13:10:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:15:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:15:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [13:15:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:15:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:15:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:15:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 124 u1: BPM st: NotStopd t0: [13:15:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 102 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [13:15:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [13:15:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:15:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [13:15:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [13:15:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 10/05/2011] 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: [13:05:00 10/05/2011] 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: [13:10:00 10/05/2011] 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: [13:15:00 10/05/2011] 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: [13:05:00 10/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd
t0: [03:40:00 10/05/2011] id: Differential-Bands Hematology el: 0 cu: MICU cg: 1663 v1: 9 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Differential-Basos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Differential-Eos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Differential-Lymphs Hematology el: 0 cu: MICU cg: 1663 v1: 3 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Differential-Monos Hematology el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [03:40:00 10/05/2011] id: Differential-Polys Hematology el: 0 cu: MICU cg: 1663 v1: 85 rs: Final st: NotStopd
t0: [13:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 7.5 vu: ml t0: [13:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [13:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1.5 vu: ml t0: [13:10:00 10/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml
t0: [13:57:00 10/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd t0: [13:57:00 10/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 10.9376 u1: ml/dl st: NotStopd t0: [13:57:00 10/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -1 rs: Final st: NotStopd t0: [13:57:00 10/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [13:57:00 10/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 34 u1: mmHg rs: Final st: NotStopd t0: [13:57:00 10/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 97 u1: mmHg rs: Final st: NotStopd t0: [13:57:00 10/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd t0: [13:57:00 10/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 98 u1: % rs: Final st: NotStopd
t0: [12:00:00 10/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [13:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [14:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 135 u1: BPM st: NotStopd t0: [14:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [14:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [14:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [14:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [14:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 10/05/2011] tf: [14:07:00 24/05/2011] dt: 20167 id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [14:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 280 vu: ml t0: [14:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [14:00:00 10/05/2011] 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 10/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [14:00:00 10/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [14:00:00 10/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.7222 u1: Deg. C st: NotStopd t0: [14:00:00 10/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.9 u1: Deg. F st: NotStopd
t0: [15:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 2 u1: mmHg st: NotStopd t0: [15:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 127 u1: BPM st: NotStopd t0: [15:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [15:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [15:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [15:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [15:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 320 vu: ml t0: [15:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [15:00:00 10/05/2011] 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: [13:45:00 10/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd t0: [13:45:00 10/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd
id: Fentanyl el: 100 cu: MICU cg: RN io: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions am: 2500 du: mcghr rt: IV Drip
io: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ra: 1.25 ru: ml/hr
tf: [12:00:00 16/05/2011] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Fentanyl Citrate v1: 2500 u1: mcg m2: D5W v2: 250 u2: ml
id: .9% Normal Saline el: 1 cu: MICU cg: RN io: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [15:00:00 10/05/2011] tf: [07:30:00 18/05/2011] dt: 11070 id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 12.5 du: mcghr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 10/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [15:30:00 10/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 33.3333 u1: ml/cmH st: NotStopd t0: [15:30:00 10/05/2011] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd t0: [15:30:00 10/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [15:30:00 10/05/2011] id: ETT Position Change el: 0 cu: MICU cg: RRT v1: Done st: NotStopd t0: [15:30:00 10/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [15:30:00 10/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [15:30:00 10/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [15:30:00 10/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [15:30:00 10/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.7 st: NotStopd t0: [15:30:00 10/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [15:30:00 10/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [15:30:00 10/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [15:30:00 10/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [15:30:00 10/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [15:30:00 10/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [15:30:00 10/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [15:30:00 10/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.8 u1: L/min st: NotStopd t0: [15:30:00 10/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [15:30:00 10/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [15:30:00 10/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [15:30:00 10/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [15:30:00 10/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [15:30:00 10/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [15:30:00 10/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [15:30:00 10/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [15:30:00 10/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [15:30:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [15:30:00 10/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [15:30:00 10/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [15:30:00 10/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [15:30:00 10/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [15:30:00 10/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [15:30:00 10/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [16:00:00 10/05/2011] id: N/A 100.0vl + 1000mcgkgmin Propofol IV Infusions el: 1 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd
t0: [16:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [16:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 103 u1: BPM st: NotStopd t0: [16:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 85 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [16:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [16:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:00:00 10/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [16:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [16:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:30:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:30:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [16:30:00 10/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:30:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:30:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:30:00 10/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:30:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:30:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:30:00 10/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:30:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:30:00 10/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:30:00 10/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:30:00 10/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:30:00 10/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: Flat in Bed st: NotStopd t0: [16:30:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 101 u1: BPM st: NotStopd t0: [16:30:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:30:00 10/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:30:00 10/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:30:00 10/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:30:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 89 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [16:30:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [16:30:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:30:00 10/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:30:00 10/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:30:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:30:00 10/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:30:00 10/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:30:00 10/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:30:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [16:30:00 10/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:30:00 10/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:30:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:30:00 10/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [16:30:00 10/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [15:00:00 10/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [16:30:00 10/05/2011] tf: [09:00:00 18/05/2011] dt: 11070 id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml nb: 1 t0: [16:00:00 10/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml t0: [16:30:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 15 vu: ml t0: [16:30:00 10/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 1.875 vu: ml t0: [16:30:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 180 vu: ml t0: [16:30:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4.5 vu: ml
t0: [16:00:00 10/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 12.5 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:00:00 10/05/2011] 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: [16:30:00 10/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 12.5 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:30:00 10/05/2011] 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 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [17:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [17:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 10/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [17:00:00 10/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [17:00:00 10/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [17:00:00 10/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 10/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [17:00:00 10/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [17:00:00 10/05/2011] id: INV Line#4 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [17:00:00 10/05/2011] id: INV Line#4InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 23 st: NotStopd t0: [17:00:00 10/05/2011] id: INV Line#4SiteAppear el: 0 cu: MICU cg: RN v1: Bleeding st: NotStopd t0: [17:00:00 10/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [17:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [17:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [17:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 10/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd t0: [17:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [17:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [17:00:00 10/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [17:00:00 10/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [17:00:00 10/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [17:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 10/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 121 rs: Manual st: NotStopd
t0: [17:30:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:30:00 10/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 1.875 vu: ml t0: [17:30:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [17:30:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [17:00:00 10/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:00:00 10/05/2011] 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: [18:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [18:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 10/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: Flat in Bed st: NotStopd t0: [18:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [18:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:00:00 10/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [18:00:00 10/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 10/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [18:00:00 10/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [18:00:00 10/05/2011] id: INV Line#4 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [18:00:00 10/05/2011] id: INV Line#4InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 23 st: NotStopd t0: [18:00:00 10/05/2011] id: INV Line#4SiteAppear el: 0 cu: MICU cg: RN v1: Bleeding st: NotStopd t0: [18:00:00 10/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [18:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [18:00:00 10/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [18:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 10/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 10/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [18:00:00 10/05/2011] 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 10/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 20.6 rs: Final st: NotStopd
t0: [19:36:00 10/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 33.3333 u1: ml/cmH st: NotStopd t0: [19:36:00 10/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [19:36:00 10/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14 t0: [19:36:00 10/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [19:36:00 10/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [19:36:00 10/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [19:36:00 10/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.7 st: NotStopd t0: [19:36:00 10/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [19:36:00 10/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [19:36:00 10/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [19:36:00 10/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [19:36:00 10/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [19:36:00 10/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [19:36:00 10/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [19:36:00 10/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9 u1: L/min st: NotStopd t0: [19:36:00 10/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [19:36:00 10/05/2011] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [19:36:00 10/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [19:36:00 10/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [19:36:00 10/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [19:36:00 10/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [19:36:00 10/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [19:36:00 10/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [19:36:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [19:36:00 10/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 498 u1: ml/B st: NotStopd t0: [19:36:00 10/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [19:36:00 10/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [19:36:00 10/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 10/05/2011] id: INV Line#4SiteAppear el: 0 cu: MICU cg: -1 st: D/C'd
t0: [20:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [20:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 10/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 10/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 10/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [20:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 102 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [20:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [20:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [20:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 10/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 10/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3889 u1: Deg. C st: NotStopd t0: [20:00:00 10/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.3 u1: Deg. F st: NotStopd t0: [20:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 25 vu: ml t0: [20:00:00 10/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 11.25 vu: ml t0: [20:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml t0: [20:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 7.5 vu: ml
t0: [20:00:00 10/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [20:00:00 10/05/2011] 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 10/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [20:00:00 10/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 10/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 10/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 10/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 10/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 10/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 10/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 10/05/2011] id: INV Line#4 D/C Date el: 0 cu: MICU cg: RN v1: 3 v2: 23 st: NotStopd t0: [20:00:00 10/05/2011] id: INV Line#4 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 10/05/2011] id: INV Line#4InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 23 st: NotStopd t0: [20:00:00 10/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 10/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd
t0: [20:00:00 10/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vu: ml st: Restart
t0: [20:57:00 10/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:57:00 10/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14 t0: [20:57:00 10/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:57:00 10/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:57:00 10/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:57:00 10/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:57:00 10/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [20:57:00 10/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:57:00 10/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:57:00 10/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [20:57:00 10/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [20:57:00 10/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:57:00 10/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:57:00 10/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [20:57:00 10/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:57:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:57:00 10/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 520 u1: ml/B st: NotStopd t0: [20:57:00 10/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:57:00 10/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:30:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:30:00 10/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [20:30:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:30:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:30:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:30:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [20:30:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [20:30:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [20:30:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:30:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [20:30:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:30:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 10/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [21:00:00 10/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 10/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [21:00:00 10/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [21:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 10/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 10/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [21:00:00 10/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [21:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 10/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [21:00:00 10/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [21:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 10/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [21:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 10/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 10/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [21:00:00 10/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [21:00:00 10/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [21:00:00 10/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [21:00:00 10/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 10/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [21:00:00 10/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [21:00:00 10/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [21:00:00 10/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [21:00:00 10/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 118 u1: BPM st: NotStopd t0: [21:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 10/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [21:00:00 10/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [21:00:00 10/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [21:00:00 10/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [21:00:00 10/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [21:00:00 10/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 10/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 10/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [21:00:00 10/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [21:00:00 10/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [21:00:00 10/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [21:00:00 10/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [21:00:00 10/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [21:00:00 10/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 10/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [21:00:00 10/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 10/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [21:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [21:00:00 10/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [21:00:00 10/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 10/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [21:00:00 10/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 10/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [21:00:00 10/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [21:00:00 10/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [21:00:00 10/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 10/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [21:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [21:00:00 10/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [21:00:00 10/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [21:00:00 10/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [21:00:00 10/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 10/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 10/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [21:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 10/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [21:00:00 10/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Rectal Tube st: NotStopd t0: [21:00:00 10/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [21:00:00 10/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [21:00:00 10/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 10/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [21:00:00 10/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 10/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [21:00:00 10/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 10/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [21:00:00 10/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [21:00:00 10/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [21:00:00 10/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [21:00:00 10/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [21:00:00 10/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [21:00:00 10/05/2011] tf: [04:00:00 11/05/2011] dt: 420 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [21:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 10/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 3.75 vu: ml t0: [21:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [21:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2.5 vu: ml
t0: [20:30:00 10/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [20:30:00 10/05/2011] 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 10/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [21:00:00 10/05/2011] 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: [11:00:00 11/05/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 50 u1: mg
t0: [22:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [22:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [22:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [22:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [22:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 10/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 10/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 10/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 10/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 10/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 10/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 10/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [23:00:00 10/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 10/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [23:00:00 10/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [23:00:00 10/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 10/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [23:00:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 10/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 10/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml t0: [23:00:00 10/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [23:00:00 10/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 10/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml t0: [23:00:00 10/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [22:00:00 10/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [22:00:00 10/05/2011] 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 10/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [23:00:00 10/05/2011] 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 10/05/2011] id: I:E Ratio el: 0 cu: MICU cg: -1 st: D/C'd t0: [23:00:00 10/05/2011] id: Peak Flow el: 0 cu: MICU cg: -1 st: D/C'd t0: [23:00:00 10/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: -1 st: D/C'd t0: [23:00:00 10/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: -1 st: D/C'd t0: [23:00:00 10/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: -1 st: D/C'd t0: [23:00:00 10/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: -1 st: D/C'd t0: [23:00:00 10/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: -1 st: D/C'd t0: [23:00:00 10/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: -1 st: D/C'd t0: [23:00:00 10/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: -1 st: D/C'd
t0: [23:30:00 10/05/2011] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [23:30:00 10/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [23:30:00 10/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14 t0: [23:30:00 10/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [23:30:00 10/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [23:30:00 10/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [23:30:00 10/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [23:30:00 10/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [23:30:00 10/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [23:30:00 10/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [23:30:00 10/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [23:30:00 10/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [23:30:00 10/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [23:30:00 10/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.3 u1: L/min st: NotStopd t0: [23:30:00 10/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [23:30:00 10/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [23:30:00 10/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 15 u1: . st: NotStopd t0: [23:30:00 10/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 21 u1: BPM st: NotStopd t0: [23:30:00 10/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [23:30:00 10/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [23:30:00 10/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [23:30:00 10/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [23:30:00 10/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 488 u1: ml/B st: NotStopd t0: [23:30:00 10/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [23:30:00 10/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 11/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 122 u1: BPM st: NotStopd t0: [00:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [00:00:00 11/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 11/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 11/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 11/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 11/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 11/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [00:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [00:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [00:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 91 u1: % st: NotStopd t0: [00:00:00 11/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 11/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [00:00:00 11/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [00:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 11/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 93 rs: Manual st: NotStopd
t0: [00:00:00 11/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [00:00:00 11/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [00:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 11/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 25 vu: ml t0: [00:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2.5 vu: ml t0: [00:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [00:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [00:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [00:00:00 11/05/2011] 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 11/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 55 ap: none
t0: [00:00:00 11/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 11/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 11/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:00:00 11/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 11/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 11/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 11/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [01:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [01:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 103 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [01:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [01:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [01:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [01:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 11/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [01:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2.5 vu: ml t0: [01:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [01:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [01:00:00 11/05/2011] 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 11/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 11/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 11/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 11/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 11/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 11/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 11/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [00:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 11/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 11/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 11/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [00:00:00 11/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [00:00:00 11/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: Serous v2: Copious st: NotStopd t0: [00:00:00 11/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [00:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 11/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [00:00:00 11/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 11/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 11/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 11/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [00:00:00 11/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 11/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 11/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 11/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 11/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Rectal Tube st: NotStopd t0: [00:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 11/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 11/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 11/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [00:00:00 11/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [00:00:00 11/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 11/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [02:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [02:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [02:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [02:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [02:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [02:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 11/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2.5 vu: ml t0: [02:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [02:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [02:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [02:00:00 11/05/2011] 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 11/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 45 cv: 45 ap: none t0: [23:00:00 11/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -27 cv: -27 ap: none t0: [23:00:00 11/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 18 cv: 3971.71 ap: none t0: [23:00:00 11/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 18 cv: 5451.71 ap: none t0: [23:00:00 11/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 300 ap: none t0: [23:00:00 11/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 45 cv: 1605 ap: none t0: [23:00:00 11/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -27 cv: 3731.71 ap: none t0: [23:00:00 11/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 45 cv: 1720 ap: none t0: [23:00:00 11/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -27 cv: 21434.8 ap: carryForward
tf: [01:00:00 11/05/2011] pt: Unit Dose rt: IM fr: TID:PRN m1: Haloperidol v1: 1 u1: mg tf: [12:00:00 17/05/2011] pt: Unit Dose rt: IV fr: TID:PRN m1: Haloperidol v1: 1 u1: mg
t0: [02:00:00 11/05/2011] id: QTc el: 0 cu: MICU cg: RN v1: 0.38 u1: sec st: NotStopd
t0: [03:40:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [03:40:00 11/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [03:40:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [03:40:00 11/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [03:40:00 11/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [03:40:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [03:40:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [03:40:00 11/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [03:40:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [03:40:00 11/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [03:40:00 11/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [03:40:00 11/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [03:40:00 11/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.4 u1: L/min st: NotStopd t0: [03:40:00 11/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [03:40:00 11/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [03:40:00 11/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 10 u1: . st: NotStopd t0: [03:40:00 11/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [03:40:00 11/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [03:40:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 95 u1: % st: NotStopd t0: [03:40:00 11/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 503 u1: ml/B st: NotStopd t0: [03:40:00 11/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [03:40:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [01:30:00 11/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 10 u1: . st: NotStopd t0: [04:02:00 11/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [04:02:00 11/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -2 rs: Final st: NotStopd t0: [04:02:00 11/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 24 rs: Final st: NotStopd t0: [04:02:00 11/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 40 u1: mmHg rs: Final st: NotStopd t0: [04:02:00 11/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 89 u1: mmHg rs: Final st: NotStopd t0: [04:02:00 11/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [04:02:00 11/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 97 u1: % rs: Final st: NotStopd
t0: [03:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [03:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [03:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [03:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [03:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 11/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 11/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 11/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 11/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [04:00:00 11/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 11/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 122 u1: BPM st: NotStopd t0: [04:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [04:00:00 11/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 11/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 11/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 11/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 11/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 11/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 11/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 11/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [04:00:00 11/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [04:00:00 11/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 157 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [04:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [04:00:00 11/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 11/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [04:00:00 11/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [04:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [04:00:00 11/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Rectal Tube st: NotStopd t0: [04:00:00 11/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 11/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 11/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [04:00:00 11/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [04:00:00 11/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 11/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [04:00:00 11/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml st: Stopped t0: [04:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [04:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml t0: [04:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml
t0: [03:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [03:00:00 11/05/2011] 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 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [04:00:00 11/05/2011] 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: [03:45:00 11/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.6 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 7.6 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 24.1 u1: % rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 7.9 u1: gm/dl rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 381 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.85 u1: /mic l rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.6 rs: Final st: NotStopd t0: [04:02:00 11/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 10.5443 u1: ml/dl st: NotStopd
t0: [03:45:00 11/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 26 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 90 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 u1: mEq/L rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 26 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 23 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 90 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 u1: mEq/L rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd t0: [03:45:00 11/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd
t0: [04:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 11/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 11/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 11/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 11/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 11/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [04:00:00 11/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 11/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [05:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [05:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [05:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [05:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [05:00:00 11/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [05:00:00 11/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [05:00:00 11/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [05:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [06:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 11/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [06:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 122 u1: BPM st: NotStopd t0: [06:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 11/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 11/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [06:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [06:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [06:00:00 11/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [06:00:00 11/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [06:00:00 11/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [06:00:00 11/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [06:00:00 11/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [06:00:00 11/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [06:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 11/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 25 vu: ml t0: [06:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml t0: [06:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml
t0: [05:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [05:00:00 11/05/2011] 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 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 250 su: ml rt: IV Drip t0: [06:00:00 11/05/2011] 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 11/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 115 ap: none
t0: [06:00:00 11/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 93 rs: Manual st: NotStopd
t0: [06:00:00 11/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 125.424 u1: units st: NotStopd t0: [06:00:00 11/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 125.424 u1: units st: NotStopd t0: [06:00:00 11/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [06:00:00 11/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.295 u1: L st: NotStopd t0: [06:00:00 11/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [06:00:00 11/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd
t0: [07:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [07:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 114 u1: BPM st: NotStopd t0: [07:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [07:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [07:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [07:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [07:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 11/05/2011] 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 11/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 20 u1: ml/cmH st: NotStopd t0: [08:00:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 11/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [08:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 11/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:00:00 11/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [08:00:00 11/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [08:00:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 11/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.3 u1: Deg. C st: NotStopd t0: [08:00:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:00:00 11/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [08:00:00 11/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [08:00:00 11/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:00:00 11/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 15.4 u1: L/min st: NotStopd t0: [08:00:00 11/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 11/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [08:00:00 11/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [08:00:00 11/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [08:00:00 11/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [08:00:00 11/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [08:00:00 11/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 84 u1: % st: NotStopd t0: [08:00:00 11/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [08:00:00 11/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [08:00:00 11/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 510 u1: ml/B st: NotStopd t0: [08:00:00 11/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [08:00:00 11/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 11/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [07:30:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:30:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [07:30:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:30:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:30:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:30:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:30:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 142 u1: BPM st: NotStopd t0: [07:30:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:30:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 183 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [07:30:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [07:30:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:30:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [07:30:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [07:30:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:35:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:35:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [07:35:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:35:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:35:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:35:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:35:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 144 u1: BPM st: NotStopd t0: [07:35:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:35:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 183 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [07:35:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 117 u1: mmHg st: NotStopd t0: [07:35:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:35:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [07:35:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [07:35:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:40:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:40:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [07:40:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:40:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:40:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:40:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:40:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 147 u1: BPM st: NotStopd t0: [07:40:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:40:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 197 u1: mmHg v2: 90 u2: mmHg st: NotStopd t0: [07:40:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 130 u1: mmHg st: NotStopd t0: [07:40:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:40:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [07:40:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [07:40:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:45:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:45:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [07:45:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:45:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:45:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:45:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:45:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 150 u1: BPM st: NotStopd t0: [07:45:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:45:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 181 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [07:45:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 123 u1: mmHg st: NotStopd t0: [07:45:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:45:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [07:45:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [07:45:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:50:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:50:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [07:50:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:50:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:50:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:50:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:50:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 151 u1: BPM st: NotStopd t0: [07:50:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:50:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 200 u1: mmHg v2: 91 u2: mmHg st: NotStopd t0: [07:50:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 130 u1: mmHg st: NotStopd t0: [07:50:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:50:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [07:50:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 92 u1: % st: NotStopd t0: [07:50:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:55:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:55:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:55:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:55:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:55:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:55:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 149 u1: BPM st: NotStopd t0: [07:55:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:55:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 209 u1: mmHg v2: 96 u2: mmHg st: NotStopd t0: [07:55:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 138 u1: mmHg st: NotStopd t0: [07:55:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:55:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [07:55:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 88 u1: % st: NotStopd t0: [07:55:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [08:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 142 u1: BPM st: NotStopd t0: [08:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 203 u1: mmHg v2: 96 u2: mmHg st: NotStopd t0: [08:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 137 u1: mmHg st: NotStopd t0: [08:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [08:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:05:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:05:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [08:05:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:05:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:05:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:05:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:05:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [08:05:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:05:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 163 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [08:05:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [08:05:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:05:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [08:05:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [08:05:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:10:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:10:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [08:10:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:10:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:10:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:10:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:10:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 120 u1: BPM st: NotStopd t0: [08:10:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:10:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [08:10:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 109 u1: mmHg st: NotStopd t0: [08:10:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:10:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [08:10:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [08:10:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:15:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:15:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [08:15:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:15:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:15:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:15:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:15:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 120 u1: BPM st: NotStopd t0: [08:15:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:15:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 173 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [08:15:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 119 u1: mmHg st: NotStopd t0: [08:15:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:15:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [08:15:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [08:15:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:20:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:20:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [08:20:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:20:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:20:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:20:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:20:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 119 u1: BPM st: NotStopd t0: [08:20:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:20:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 167 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [08:20:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [08:20:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:20:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [08:20:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [08:20:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:25:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:25:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [08:25:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:25:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:25:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:25:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:25:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [08:25:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:25:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 181 u1: mmHg v2: 98 u2: mmHg st: NotStopd t0: [08:25:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 128 u1: mmHg st: NotStopd t0: [08:25:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:25:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [08:25:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 92 u1: % st: NotStopd t0: [08:25:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:30:00 11/05/2011] 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: [07:35:00 11/05/2011] 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: [07:40:00 11/05/2011] 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: [07:45:00 11/05/2011] 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: [07:50:00 11/05/2011] 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: [07:55:00 11/05/2011] 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 11/05/2011] 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: [08:05:00 11/05/2011] 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: [08:10:00 11/05/2011] 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: [08:15:00 11/05/2011] 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: [08:20:00 11/05/2011] 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: [08:25:00 11/05/2011] 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: [07:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip
t0: [08:30:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:30:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [08:30:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:30:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:30:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:30:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:30:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 119 u1: BPM st: NotStopd t0: [08:30:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:30:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 168 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [08:30:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [08:30:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:30:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [08:30:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 91 u1: % st: NotStopd t0: [08:30:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:30:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [07:35:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [07:40:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [07:45:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [07:50:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [07:55:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:05:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:10:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:15:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:20:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:25:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:30:00 11/05/2011] 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: [07:30:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [07:30:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [07:30:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [07:30:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [07:30:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [07:30:00 11/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [07:30:00 11/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [07:30:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [07:45:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [07:45:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [07:45:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [07:45:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [07:45:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd
t0: [07:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [07:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2.5 vu: ml t0: [07:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml t0: [08:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 240 vu: ml t0: [08:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [08:00:00 11/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 11/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 11/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 11/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.4444 u1: Deg. C st: NotStopd t0: [08:00:00 11/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 101.2 u1: Deg. F st: NotStopd
tf: [16:00:00 11/05/2011] pt: Unit Dose rt: IV fr: ASDIR m1: Metoprolol v1: 5 u1: mg
t0: [08:00:00 11/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: EKG st: NotStopd t0: [08:00:00 11/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:45:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:45:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [08:45:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:45:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:45:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:45:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:45:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 117 u1: BPM st: NotStopd t0: [08:45:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:45:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [08:45:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [08:45:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:45:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [08:45:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [08:45:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [09:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [09:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [09:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [09:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [09:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [09:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:30:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:45:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:45:00 11/05/2011] 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 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:00:00 11/05/2011] 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 11/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 11/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 11/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 11/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 11/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Swelling st: NotStopd t0: [08:00:00 11/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [08:00:00 11/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 11/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 11/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [08:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 7 u1: points st: NotStopd t0: [08:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 11/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 11/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 11/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [08:00:00 11/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 11/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 11/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 11/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 11/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 11/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 11/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 11/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [08:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 11/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 11/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 11/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 11/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 11/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 11/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 11/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 11/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 11/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 11/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [08:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 11/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 11/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 11/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 11/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [08:00:00 11/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 11/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 11/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [08:00:00 11/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 11/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [09:00:00 11/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [09:00:00 11/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [09:00:00 11/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [09:00:00 11/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Swelling st: NotStopd t0: [09:00:00 11/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:00:00 11/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [09:00:00 11/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [09:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [09:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [09:00:00 11/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Fam Talked to RN st: NotStopd t0: [09:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [09:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 7 u1: points st: NotStopd t0: [09:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [09:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [09:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [09:00:00 11/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [09:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [09:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [09:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [09:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [09:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 11/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [09:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [09:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [09:00:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [09:00:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [09:00:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [09:00:00 11/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 11/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [09:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [09:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [09:00:00 11/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 11/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [09:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [09:00:00 11/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 11/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 11/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [09:00:00 11/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [09:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [09:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [09:00:00 11/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [09:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 11/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [09:00:00 11/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [09:00:00 11/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [09:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 11/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [09:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [09:00:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [09:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [09:00:00 11/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [09:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [09:15:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:15:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [09:15:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:15:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:15:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:15:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:15:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 124 u1: BPM st: NotStopd t0: [09:15:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:15:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [09:15:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [09:15:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:15:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [09:15:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [09:15:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:30:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:30:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [09:30:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 125 u1: BPM st: NotStopd t0: [09:30:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:30:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [09:30:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [09:30:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:30:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [09:30:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [09:30:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:45:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:45:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [09:45:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:45:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:45:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:45:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:45:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 127 u1: BPM st: NotStopd t0: [09:45:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:45:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [09:45:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [09:45:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:45:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [09:45:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [09:45:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 11/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [10:00:00 11/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [10:00:00 11/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Swelling st: NotStopd t0: [10:00:00 11/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [10:00:00 11/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [10:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [10:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [10:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 7 u1: points st: NotStopd t0: [10:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [10:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [10:00:00 11/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [10:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [10:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [10:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [10:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 11/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [10:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [10:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [10:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [10:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [10:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [10:00:00 11/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [10:00:00 11/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 11/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [10:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 11/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [10:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 11/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [10:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 11/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [10:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [10:00:00 11/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [10:00:00 11/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [10:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [10:00:00 11/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [10:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [09:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.25 vu: ml t0: [09:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [09:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml t0: [10:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 7.5 vu: ml t0: [10:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [10:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [09:15:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:15:00 11/05/2011] 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: [09:30:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:30:00 11/05/2011] 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: [09:45:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:45:00 11/05/2011] 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
tf: [10:00:00 13/05/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Prednisone v1: 10 u1: mg
t0: [11:00:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [11:00:00 11/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [11:00:00 11/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [11:00:00 11/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [11:00:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [11:00:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [11:00:00 11/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [11:00:00 11/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [11:00:00 11/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [11:00:00 11/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.8 u1: L/min st: NotStopd t0: [11:00:00 11/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [11:00:00 11/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 11/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 10 u1: . st: NotStopd t0: [11:00:00 11/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [11:00:00 11/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [11:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [11:00:00 11/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [11:00:00 11/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [11:00:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:30:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:30:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [08:30:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:30:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:30:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:30:00 11/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:30:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [11:11:00 11/05/2011] id: Blood Products Hematology el: 0 cu: MICU cg: 1663 v1: Y rs: Final st: NotStopd
t0: [10:00:00 11/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [10:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [10:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 11/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 11/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [10:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [10:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 129 u1: BPM st: NotStopd t0: [10:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [10:00:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [10:00:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [10:00:00 11/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [10:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [10:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [10:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [10:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:15:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:15:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [10:15:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:15:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:15:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:15:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:15:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 131 u1: BPM st: NotStopd t0: [10:15:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:15:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 82 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [10:15:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [10:15:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:15:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [10:15:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:15:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:30:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:30:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [10:30:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:30:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:30:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 134 u1: BPM st: NotStopd t0: [10:30:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:30:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 93 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [10:30:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [10:30:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:30:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [10:30:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:30:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:45:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:45:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [10:45:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:45:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:45:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:45:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:45:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 131 u1: BPM st: NotStopd t0: [10:45:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:45:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 86 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [10:45:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [10:45:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:45:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [10:45:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 11/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [11:00:00 11/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [11:00:00 11/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [11:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [11:00:00 11/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Swelling st: NotStopd t0: [11:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 11/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 11/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [11:00:00 11/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [11:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [11:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 7 u1: points st: NotStopd t0: [11:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [11:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [11:00:00 11/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [11:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 124 u1: BPM st: NotStopd t0: [11:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [11:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [11:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [11:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [11:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 87 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [11:00:00 11/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [11:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [11:00:00 11/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [11:00:00 11/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [11:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [11:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [11:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [11:00:00 11/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [11:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 11/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [11:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [11:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [11:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 11/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [11:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [11:15:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:15:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [11:15:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:15:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:15:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:15:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:15:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 117 u1: BPM st: NotStopd t0: [11:15:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:15:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 92 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [11:15:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [11:15:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:15:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [11:15:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:15:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 7.5 vu: ml t0: [11:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [11:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [10:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:00:00 11/05/2011] 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: [10:15:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:15:00 11/05/2011] 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 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:30:00 11/05/2011] 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: [10:45:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:45:00 11/05/2011] 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: [11:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:00:00 11/05/2011] 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: [11:15:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:15:00 11/05/2011] 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: [11:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [11:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [11:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [11:30:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:30:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [11:30:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:30:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [11:30:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:30:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 88 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [11:30:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [11:30:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:30:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [11:30:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:30:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 11/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 1000 vu: ml
t0: [11:30:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:30:00 11/05/2011] 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
tf: [11:00:00 12/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 12 dn: 1 m1: Magnesium Sulfate v1: 4 u1: gm m2: NS v2: 250 u2: ml tf: [12:00:00 12/05/2011] 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
id: Packed RBC's el: 1 cu: MICU cg: RN io: Packed RBC's IV Infusions du: ml rt: Intravenous Push
t0: [11:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [12:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [12:00:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [12:00:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 90 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [12:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [12:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [12:00:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [12:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 11/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 250 vu: ml t0: [12:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [12:00:00 11/05/2011] tf: [15:00:00 13/05/2011] dt: 3060 id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: 109 vo: 375 vu: ml t0: [12:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [12:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [12:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:00:00 11/05/2011] 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 11/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 11/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 11/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 11/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [12:00:00 11/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd
t0: [11:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [11:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 11/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [11:00:00 11/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [11:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [11:00:00 11/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [12:00:00 11/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 11/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 11/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 11/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Swelling st: NotStopd t0: [12:00:00 11/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 11/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 11/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [12:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 7 u1: points st: NotStopd t0: [12:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 11/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [12:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [12:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 11/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [12:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 11/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 11/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [12:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 11/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [12:00:00 11/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [12:00:00 11/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 11/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 11/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 11/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 11/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [12:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 11/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 11/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [12:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 11/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [12:30:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:30:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:30:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:30:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:30:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 114 u1: BPM st: NotStopd t0: [12:30:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:30:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [12:30:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [12:30:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:30:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [12:30:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 11/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [13:00:00 11/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [13:00:00 11/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [13:00:00 11/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Swelling st: NotStopd t0: [13:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 11/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 11/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [13:00:00 11/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [13:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [13:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [13:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [13:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 7 u1: points st: NotStopd t0: [13:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [13:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [13:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [13:00:00 11/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [13:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [13:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [13:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [13:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [13:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [13:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [13:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 11/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [13:00:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [13:00:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [13:00:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [13:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [13:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [13:00:00 11/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [13:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 89 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [13:00:00 11/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [13:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [13:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [13:00:00 11/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 11/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [13:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [13:00:00 11/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [13:00:00 11/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 11/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [13:00:00 11/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [13:00:00 11/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [13:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [13:00:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [13:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [13:00:00 11/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 11/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [13:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [13:30:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:30:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:30:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:30:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [13:30:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:30:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [13:30:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 55 u1: mmHg st: NotStopd t0: [13:30:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:30:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [13:30:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [13:30:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [13:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 160 vu: ml t0: [13:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [12:30:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:30:00 11/05/2011] 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 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [13:00:00 11/05/2011] 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: [13:30:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [13:30:00 11/05/2011] 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: [14:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [14:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [14:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [14:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [14:00:00 11/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [14:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 11/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml t0: [14:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [14:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [14:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip
t0: [15:00:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [15:00:00 11/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [15:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [15:00:00 11/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [15:00:00 11/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [15:00:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [15:00:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [15:00:00 11/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [15:00:00 11/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [15:00:00 11/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [15:00:00 11/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 6.2 u1: L/min st: NotStopd t0: [15:00:00 11/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [15:00:00 11/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [15:00:00 11/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 10 u1: . st: NotStopd t0: [15:00:00 11/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 11 u1: BPM st: NotStopd t0: [15:00:00 11/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [15:00:00 11/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 549 u1: ml/B st: NotStopd t0: [15:00:00 11/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [15:00:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
id: Neosynephrine-k el: 100 cu: MICU 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: MICU cg: RN ra: 0.5 ru: ml/hr
id: D5W el: 1 cu: MICU cg: RN io: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [16:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [16:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [16:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 78 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [16:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:05:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:05:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [16:05:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:05:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:05:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:05:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 41 u1: BPM st: NotStopd t0: [16:05:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 170 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [16:05:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 117 u1: mmHg st: NotStopd t0: [16:05:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:05:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:05:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:10:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:10:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [16:10:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:10:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:10:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:10:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [16:10:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:10:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 157 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [16:10:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [16:10:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:10:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [16:10:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:10:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 11/05/2011] tf: [14:07:00 24/05/2011] dt: 18607 id: Neosynephrine-k el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 11/05/2011] 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: [16:00:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.0345066 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:05:00 11/05/2011] 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: [16:05:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:10:00 11/05/2011] 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: [16:00:00 11/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd
t0: [16:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [16:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 8 vu: ml
t0: [16:15:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:15:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [16:15:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:15:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:15:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:15:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [16:15:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [16:15:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [16:15:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:15:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [16:15:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:15:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:20:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:20:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [16:20:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:20:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:20:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:20:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [16:20:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 89 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [16:20:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [16:20:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:20:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:20:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:20:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:25:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:25:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [16:25:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:25:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:25:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:25:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [16:25:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 83 u1: mmHg v2: 43 u2: mmHg st: NotStopd t0: [16:25:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [16:25:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:25:00 11/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Trach Percutan st: NotStopd t0: [16:25:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:25:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:25:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:30:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:30:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [16:30:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:30:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:30:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:30:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [16:30:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 82 u1: mmHg v2: 42 u2: mmHg st: NotStopd t0: [16:30:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 58 u1: mmHg st: NotStopd t0: [16:30:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:30:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:30:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:30:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:15:00 11/05/2011] 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: [16:15:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:20:00 11/05/2011] 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: [16:20:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:25:00 11/05/2011] 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: [16:25:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:30:00 11/05/2011] 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: [16:30:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [15:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [15:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 90 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [15:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [15:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 11 u1: BPM st: NotStopd t0: [15:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 11/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 11/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:05:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [16:10:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:15:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:15:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:20:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:20:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:25:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:25:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:30:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:30:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:35:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:35:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [16:35:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:35:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:35:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:35:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:35:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [16:35:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:35:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 92 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [16:35:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [16:35:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:35:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:35:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:35:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:40:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:40:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [16:40:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:40:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:40:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:40:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 82 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [16:40:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 58 u1: mmHg st: NotStopd t0: [16:40:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:40:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:40:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:45:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:45:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [16:45:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:45:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:45:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:45:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:45:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [16:45:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:45:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 89 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [16:45:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [16:45:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:45:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:45:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:45:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:50:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:50:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [16:50:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:50:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:50:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:50:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:50:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [16:50:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:50:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 92 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [16:50:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [16:50:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:50:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:50:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:50:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:55:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:55:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [16:55:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:55:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:55:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:55:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:55:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [16:55:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:55:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 89 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [16:55:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [16:55:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:55:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:55:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:55:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [17:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 11/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [17:00:00 11/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [17:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 91 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [17:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [17:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [17:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [15:00:00 11/05/2011] 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: [16:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:05:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:10:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:15:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:20:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:25:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:30:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:35:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:35:00 11/05/2011] 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: [16:35:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:40:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:40:00 11/05/2011] 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: [16:40:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:45:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:45:00 11/05/2011] 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: [16:45:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:50:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:50:00 11/05/2011] 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: [16:50:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:55:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:55:00 11/05/2011] 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: [16:55:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:00:00 11/05/2011] 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: [17:00:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [08:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [09:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [10:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [11:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [12:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [13:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [14:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 11/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [14:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [14:00:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [14:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [14:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [14:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [14:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 7 u1: points st: NotStopd t0: [14:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [14:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [14:00:00 11/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [14:00:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [14:00:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [14:00:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [14:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [14:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [14:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [14:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [16:00:00 11/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 11/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 11/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [16:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [16:00:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [16:00:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [16:00:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 11/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [17:00:00 11/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:00:00 11/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [17:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [17:00:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [17:00:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [17:00:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [17:00:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd
t0: [17:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.45833 vu: ml t0: [17:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [17:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [13:00:00 11/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [13:00:00 11/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [13:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [13:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [13:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [13:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [13:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [13:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [13:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [13:00:00 11/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [13:00:00 11/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [13:00:00 11/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Comp. Immobile st: NotStopd t0: [13:00:00 11/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [13:00:00 11/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [13:00:00 11/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 11 u1: number st: NotStopd t0: [13:00:00 11/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Comp. Limited st: NotStopd t0: [14:00:00 11/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [14:00:00 11/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 11/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Swelling st: NotStopd t0: [14:00:00 11/05/2011] id: Family Meeting el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [14:00:00 11/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [14:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [14:00:00 11/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 11/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [14:00:00 11/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [14:00:00 11/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 11/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 11/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [14:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [14:00:00 11/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [14:00:00 11/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 11/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 11/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [14:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 11/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 11/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [14:00:00 11/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [14:00:00 11/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [14:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 11/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 11/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 11/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [15:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [15:00:00 11/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [15:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [15:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [15:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [15:00:00 11/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [15:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 7 u1: points st: NotStopd t0: [15:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [15:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [15:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [15:00:00 11/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [15:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [15:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [15:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [15:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [15:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [15:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [15:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [15:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [15:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [15:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [15:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [15:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [15:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [15:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [15:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [15:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [15:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [15:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [16:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [16:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [16:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [16:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [16:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [17:00:00 11/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [17:00:00 11/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [17:00:00 11/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Swelling st: NotStopd t0: [17:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [17:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [17:00:00 11/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [17:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [17:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [17:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [17:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [17:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [17:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [17:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [17:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [17:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 11/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [17:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [17:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [17:00:00 11/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [17:00:00 11/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [17:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [17:00:00 11/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 11/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [17:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [17:00:00 11/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 11/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [17:00:00 11/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [17:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [17:00:00 11/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [17:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [17:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [17:00:00 11/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [17:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [17:00:00 11/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [17:00:00 11/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [17:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [17:00:00 11/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 11/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [17:00:00 11/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [17:00:00 11/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Comp. Immobile st: NotStopd t0: [17:00:00 11/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [17:00:00 11/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [17:00:00 11/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 11 u1: number st: NotStopd t0: [17:00:00 11/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Comp. Limited st: NotStopd t0: [17:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [17:00:00 11/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thin st: NotStopd t0: [17:00:00 11/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Expectorated v2: Small st: NotStopd t0: [18:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [18:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [18:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [18:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [18:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [18:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [18:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [18:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [18:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [18:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [18:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [18:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [18:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [18:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 95 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [18:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [18:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [18:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [18:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [18:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [18:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [16:00:00 11/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 1000 vu: ml t0: [17:00:00 11/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml t0: [17:00:00 11/05/2011] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: 109 vo: 375 vu: ml t0: [18:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [18:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [18:00:00 11/05/2011] 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 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [18:00:00 11/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 75 rs: Manual st: NotStopd
t0: [20:00:00 11/05/2011] id: INV#2Chg o/Wire Date el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 11/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 11/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 11/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 11/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 11/05/2011] id: INV Line#2 Site Date el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 11/05/2011] id: INV Line#2 Zero/Cal el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 11/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 11/05/2011] id: INV#2 WaveformAppear el: 0 cu: MICU cg: -1 st: D/C'd
t0: [20:00:00 11/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 24 st: NotStopd t0: [20:00:00 11/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 30.5556 u1: ml/cmH st: NotStopd t0: [20:00:00 11/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 11/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 11/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [20:00:00 11/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [20:00:00 11/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 11/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.7 st: NotStopd t0: [20:00:00 11/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 11/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 11/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 11/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:00:00 11/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 11/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:00:00 11/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [20:00:00 11/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [20:00:00 11/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [20:00:00 11/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 11/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [20:00:00 11/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [20:00:00 11/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [20:00:00 11/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [20:00:00 11/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:00:00 11/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 11/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 11/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 514 u1: ml/B st: NotStopd t0: [20:00:00 11/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [20:00:00 11/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 11/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [20:00:00 11/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 11/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [20:00:00 11/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 11/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [19:30:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:30:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [19:30:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:30:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [19:30:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [19:30:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [19:30:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:30:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [19:30:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 11/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 11/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 2 u1: mmHg st: NotStopd t0: [20:00:00 11/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 11/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 11/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 11/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 11/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [20:00:00 11/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 11/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 11/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 11/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 11/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 11/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 11/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 11/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 11/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [20:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 11/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 11/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 11/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [20:00:00 11/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 11/05/2011] id: INV Line#2 D/C Date el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [20:00:00 11/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left Subclavian st: NotStopd t0: [20:00:00 11/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 11/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 11/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 11/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 11/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 11/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 11/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 11/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 11/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [20:00:00 11/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 11/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 11/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 11/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 11/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 11/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 11/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [20:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [20:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [20:00:00 11/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 11/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 11/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 11/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 11/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: EKG st: NotStopd t0: [20:00:00 11/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [20:00:00 11/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 11/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 11/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [20:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 11/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 11/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 11/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Pale st: NotStopd t0: [20:00:00 11/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 11/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Clammy st: NotStopd t0: [20:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 11/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 11/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [20:00:00 11/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [20:00:00 11/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [20:00:00 11/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 11/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [20:00:00 11/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 11/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 11/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 11/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 11/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [20:00:00 11/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [20:00:00 11/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 11/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 11/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [20:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [20:00:00 11/05/2011] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: 109 vo: 375 vu: ml t0: [20:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [20:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [19:30:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [19:30:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [20:00:00 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 11/05/2011] dt: 24 id: Blood Products Total el: 2 cu: MICU cg: RN cv: 1125 ap: none
t0: [20:00:00 11/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 11/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 11/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [21:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 1 u1: mmHg st: NotStopd t0: [21:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [21:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 11/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [21:00:00 11/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [21:00:00 11/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 11/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [21:00:00 11/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [21:00:00 11/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [21:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [21:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [21:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 11/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [21:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [19:30:00 11/05/2011] 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 11/05/2011] 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 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [21:00:00 11/05/2011] 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 11/05/2011] id: Neosynephrine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [22:00:00 11/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 11/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 1 u1: mmHg st: NotStopd t0: [22:00:00 11/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 11/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [22:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [22:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 11/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [22:00:00 11/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [22:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [22:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [22:00:00 11/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 11/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 11/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [22:00:00 11/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 11/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 11/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 11/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 11/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [22:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [22:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml t0: [22:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [22:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [22:00:00 11/05/2011] 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 11/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 11/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 0 u1: mmHg st: NotStopd t0: [23:00:00 11/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 11/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 11/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 11/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 11/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 11/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [23:00:00 11/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 11/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [23:00:00 11/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [23:00:00 11/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 11/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [23:00:00 11/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 11/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 11/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 11/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 11/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml t0: [23:00:00 11/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [23:00:00 11/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [23:00:00 11/05/2011] 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 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 24 st: NotStopd t0: [00:00:00 12/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 30.5556 u1: ml/cmH st: NotStopd t0: [00:00:00 12/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 12/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [00:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [00:00:00 12/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 12/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [00:00:00 12/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.7 st: NotStopd t0: [00:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 12/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [00:00:00 12/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 12/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [00:00:00 12/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 12/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.8 u1: L/min st: NotStopd t0: [00:00:00 12/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 12/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 12/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [00:00:00 12/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [00:00:00 12/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [00:00:00 12/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [00:00:00 12/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [00:00:00 12/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [00:00:00 12/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thin st: NotStopd t0: [00:00:00 12/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [00:00:00 12/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 540 u1: ml/B st: NotStopd t0: [00:00:00 12/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [00:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [00:00:00 12/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [00:00:00 12/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 12/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [00:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 12/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 124 u1: BPM st: NotStopd t0: [00:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [00:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [00:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [00:00:00 12/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 12/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [00:00:00 12/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [00:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [00:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [00:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [00:00:00 12/05/2011] 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 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 12/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 12/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 12/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [00:00:00 12/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [00:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 12/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 12/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 12/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 12/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 12/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 12/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 12/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 12/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [00:00:00 12/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 12/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 12/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 12/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 12/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 12/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 12/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 12/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 12/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 12/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 12/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 12/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 12/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 12/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 12/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 12/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 12/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [00:00:00 12/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 12/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 12/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 12/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 12/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 12/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 12/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 12/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 12/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 12/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [00:00:00 12/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 12/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 12/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 12/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 65 rs: Manual st: NotStopd t0: [00:00:00 12/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 12/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [00:00:00 12/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [00:00:00 12/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 12/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 12/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [00:00:00 12/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [00:45:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:45:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [00:45:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:45:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:45:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:45:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:45:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:45:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [00:45:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:45:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [00:45:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [00:45:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:45:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [00:45:00 12/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [00:45:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [00:45:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:45:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [00:45:00 12/05/2011] 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 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [01:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [01:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [01:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [01:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [01:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [02:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [02:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [02:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [02:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [02:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [02:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [02:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [02:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [02:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [02:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 12/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 500 vu: ml t0: [01:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 25 vu: ml t0: [01:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml t0: [02:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml t0: [02:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [01:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [01:00:00 12/05/2011] 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 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [02:00:00 12/05/2011] 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 12/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 12/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RRT pv: 118 cv: 118 ap: none t0: [23:00:00 12/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RRT pv: 88 cv: 3657 ap: none t0: [23:00:00 12/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RRT pv: 118 cv: 3687 ap: none t0: [23:00:00 12/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 1435 ap: none t0: [23:00:00 12/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RRT pv: 118 cv: 2252 ap: carryForward t0: [23:00:00 12/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 1435 ap: carryForward t0: [23:00:00 12/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RRT pv: 118 cv: 23686.8 ap: carryForward
t0: [00:00:00 12/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Restless st: NotStopd t0: [03:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [03:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [03:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [03:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [03:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [03:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [03:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [04:00:00 12/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 12/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 12/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 12/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [04:00:00 12/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [04:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 12/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 12/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 12/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 12/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 12/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 12/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [04:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 12/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 12/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 12/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [04:00:00 12/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 12/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 12/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 12/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 12/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 12/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 12/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 12/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 12/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 12/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 12/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 12/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 12/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 12/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 12/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 12/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 12/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 12/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 95 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [04:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [04:00:00 12/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 12/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 12/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 12/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 12/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 12/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [04:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 12/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 12/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 12/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.2778 u1: Deg. C st: NotStopd t0: [04:00:00 12/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.3 u1: Deg. F st: NotStopd t0: [04:00:00 12/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [04:00:00 12/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 12/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [04:00:00 12/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 12/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 12/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 12/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Restless st: NotStopd t0: [04:00:00 12/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 78 rs: Manual st: NotStopd t0: [04:00:00 12/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 12/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [04:00:00 12/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [04:00:00 12/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 12/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 12/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [03:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [03:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml t0: [04:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [04:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [04:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [03:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [03:00:00 12/05/2011] 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 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [04:00:00 12/05/2011] 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 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 24 st: NotStopd t0: [04:00:00 12/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 27.5 u1: ml/cmH st: NotStopd t0: [04:00:00 12/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 12/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [04:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [04:00:00 12/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:00:00 12/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [04:00:00 12/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.7 st: NotStopd t0: [04:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 12/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [04:00:00 12/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 12/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:00:00 12/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [04:00:00 12/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [04:00:00 12/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:00:00 12/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 12/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [04:00:00 12/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [04:00:00 12/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [04:00:00 12/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [04:00:00 12/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [04:00:00 12/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:00:00 12/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 540 u1: ml/B st: NotStopd t0: [04:00:00 12/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [04:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [04:00:00 12/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [04:00:00 12/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 12/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [05:00:00 12/05/2011] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: PEEP >10 st: NotStopd
t0: [05:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [05:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [05:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 91 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [05:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [05:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [05:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml t0: [05:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [05:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [05:00:00 12/05/2011] 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
tf: [04:00:00 13/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 5 dn: 1 m1: Dextrose 50% v1: 12.5 u1: gm
t0: [04:00:00 12/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.2 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 9.2 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 29.9 u1: % rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.2 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 284 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.55 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.2 rs: Final st: NotStopd
t0: [04:00:00 12/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.5 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 62 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.5 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 62 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd
t0: [04:00:00 12/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [04:00:00 12/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd
t0: [06:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [06:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [06:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [06:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [06:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [06:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [06:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [06:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [06:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [06:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [06:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [06:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [06:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [06:00:00 12/05/2011] 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 12/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 80 rs: Manual st: NotStopd
t0: [06:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml
t0: [07:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [07:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [07:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 99 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [07:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [07:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [07:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [07:00:00 12/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [07:00:00 12/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [07:00:00 12/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [07:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [07:00:00 12/05/2011] 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: [07:38:00 12/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd t0: [07:38:00 12/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 13.8534 u1: ml/dl st: NotStopd t0: [07:38:00 12/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -4 rs: Final st: NotStopd t0: [07:38:00 12/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [07:38:00 12/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 36 u1: mmHg rs: Final st: NotStopd t0: [07:38:00 12/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 148 u1: mmHg rs: Final st: NotStopd t0: [07:38:00 12/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd t0: [07:38:00 12/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 98 u1: % rs: Final st: NotStopd
t0: [07:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [07:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [07:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [07:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [07:00:00 12/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [07:00:00 12/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [07:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [07:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [07:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [07:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [07:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [07:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [07:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [07:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [07:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [07:00:00 12/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [07:00:00 12/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [07:00:00 12/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [07:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [07:00:00 12/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [07:00:00 12/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [07:00:00 12/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Comp. Immobile st: NotStopd t0: [07:00:00 12/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [07:00:00 12/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [07:00:00 12/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 10 u1: number st: NotStopd t0: [07:00:00 12/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 12/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 12/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [08:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 12/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 12/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 12/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 12/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 12/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [08:00:00 12/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 12/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 12/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 12/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [08:00:00 12/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 12/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 12/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 12/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 124 u1: BPM st: NotStopd t0: [08:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 12/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 12/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [08:00:00 12/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 12/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 12/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 12/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 12/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [08:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [08:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 12/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [08:00:00 12/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 12/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 12/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 12/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 12/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 12/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [08:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [08:00:00 12/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [08:00:00 12/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [08:00:00 12/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [08:00:00 12/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 12/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 12/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 12/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [08:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [08:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [08:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [08:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [08:00:00 12/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 12/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 12/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [08:00:00 12/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 12/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 12/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 12/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [08:00:00 12/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 12/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [07:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [07:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml t0: [08:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 140 vu: ml t0: [08:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [08:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:00:00 12/05/2011] 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 12/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 20.4 rs: Final st: NotStopd
t0: [08:30:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 24 st: NotStopd t0: [08:30:00 12/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:30:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:30:00 12/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [08:30:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [08:30:00 12/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [08:30:00 12/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [08:30:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:30:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:30:00 12/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [08:30:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:30:00 12/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:30:00 12/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [08:30:00 12/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [08:30:00 12/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.5 u1: L/min st: NotStopd t0: [08:30:00 12/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:30:00 12/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:30:00 12/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 10 u1: . st: NotStopd t0: [08:30:00 12/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [08:30:00 12/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:30:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [08:30:00 12/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [08:30:00 12/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [08:30:00 12/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 400 u1: ml/B st: NotStopd t0: [08:30:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:30:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [08:30:00 12/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:30:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [08:30:00 12/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Support st: NotStopd t0: [08:30:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [09:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [09:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 146 u1: BPM st: NotStopd t0: [09:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 164 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [09:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [09:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [09:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [09:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:00:00 12/05/2011] 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: [18:00:00 11/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 90 vu: ml
t0: [09:00:00 12/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [09:00:00 12/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [09:00:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [09:00:00 12/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:00:00 12/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [09:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [09:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [09:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [09:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [09:00:00 12/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [09:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [09:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [09:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [09:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd
t0: [09:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [09:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [09:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [09:48:00 12/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.3 rs: Final st: NotStopd t0: [09:48:00 12/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 13.8007 u1: ml/dl st: NotStopd t0: [09:48:00 12/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -6 rs: Final st: NotStopd t0: [09:48:00 12/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [09:48:00 12/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 38 u1: mmHg rs: Final st: NotStopd t0: [09:48:00 12/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 131 u1: mmHg rs: Final st: NotStopd t0: [09:48:00 12/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.3 rs: Final st: NotStopd t0: [09:48:00 12/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 98 u1: % rs: Final st: NotStopd
t0: [08:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN u1: mmHg st: NotStopd t0: [08:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [09:00:00 12/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Fam Talked to RN st: NotStopd t0: [09:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [09:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [09:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [09:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [09:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [09:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [10:00:00 12/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [10:00:00 12/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [10:00:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [10:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [10:00:00 12/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [10:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 12/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 12/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 12/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [10:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [10:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [10:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 12/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [10:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [10:00:00 12/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [10:00:00 12/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 12/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [10:00:00 12/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [10:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 117 u1: BPM st: NotStopd t0: [10:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 12/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [10:00:00 12/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 12/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [10:00:00 12/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [10:00:00 12/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [10:00:00 12/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 12/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [10:00:00 12/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [10:00:00 12/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [10:00:00 12/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [10:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [10:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [10:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [10:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [10:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 12/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [10:00:00 12/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [10:00:00 12/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [10:00:00 12/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [10:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [10:00:00 12/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [10:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [10:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 12/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [10:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [10:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [10:00:00 12/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [10:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [10:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [10:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [10:00:00 12/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [10:00:00 12/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [10:00:00 12/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [10:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 12/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [10:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml t0: [10:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [10:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:00:00 12/05/2011] 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: [11:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [11:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [11:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [11:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [11:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [11:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 12/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [11:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 90 vu: ml t0: [11:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [11:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:00:00 12/05/2011] 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 12/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [09:00:00 12/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd
t0: [11:00:00 12/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [11:00:00 12/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [11:00:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [11:00:00 12/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 12/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [11:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [11:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [11:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [11:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 12/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [11:00:00 12/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Plug st: NotStopd t0: [11:00:00 12/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [11:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [11:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [11:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [11:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd
t0: [08:00:00 12/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [09:00:00 12/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [09:00:00 12/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Changed st: NotStopd t0: [10:00:00 12/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [11:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [11:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 12/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [11:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [11:00:00 12/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [11:00:00 12/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [11:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [11:00:00 12/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [11:00:00 12/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [11:00:00 12/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 12/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [11:00:00 12/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [11:00:00 12/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [11:00:00 12/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 12/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 12/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [11:00:00 12/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [11:00:00 12/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [11:00:00 12/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serous v2: Scant st: NotStopd t0: [11:00:00 12/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: Serous v2: Small st: NotStopd t0: [11:00:00 12/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [11:00:00 12/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red/Purple st: NotStopd t0: [11:00:00 12/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [11:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [11:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [11:00:00 12/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [11:00:00 12/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 12/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [11:00:00 12/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [11:00:00 12/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [11:00:00 12/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 12/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [11:00:00 12/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 12/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 12/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [11:00:00 12/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [11:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 12/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [11:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [11:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [11:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [11:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 12/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [11:00:00 12/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Clammy st: NotStopd t0: [11:00:00 12/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [11:00:00 12/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 12/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [11:00:00 12/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [11:00:00 12/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [11:00:00 12/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [11:00:00 12/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [11:00:00 12/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [11:00:00 12/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [11:00:00 12/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Comp. Immobile st: NotStopd t0: [11:00:00 12/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [11:00:00 12/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [11:00:00 12/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 10 u1: number st: NotStopd t0: [11:00:00 12/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [11:00:00 12/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [11:00:00 12/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [11:00:00 12/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [11:00:00 12/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [12:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [12:00:00 12/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 12/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [12:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 12/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 12/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 12/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 12/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 12/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 12/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 12/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 147 u1: BPM st: NotStopd t0: [12:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 12/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [12:00:00 12/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 12/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [12:00:00 12/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 12/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 12/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 12/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [12:00:00 12/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 12/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 12/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 12/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 12/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 12/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 12/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 12/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 12/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 12/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 12/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 168 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [12:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 198 u1: mmHg st: NotStopd t0: [12:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 12/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 12/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 12/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [12:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [12:00:00 12/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [12:00:00 12/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 12/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 12/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 12/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [12:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:00:00 12/05/2011] 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 12/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 12/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [12:00:00 12/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 12/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 12/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd
t0: [12:00:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [12:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [12:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [12:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [12:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 12/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Plug st: NotStopd t0: [12:00:00 12/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [12:00:00 12/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 12/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [12:00:00 12/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [12:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [12:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [12:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [12:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [12:15:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:15:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [12:15:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:15:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:15:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:15:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:15:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:15:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 144 u1: BPM st: NotStopd t0: [12:15:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:15:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [12:15:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [12:15:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:15:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [12:15:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [12:15:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:30:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:30:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [12:30:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:30:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:30:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:30:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 141 u1: BPM st: NotStopd t0: [12:30:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:30:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [12:30:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [12:30:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:30:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [12:30:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [12:30:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [12:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 130 vu: ml t0: [12:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [12:15:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:15:00 12/05/2011] 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: [12:30:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:30:00 12/05/2011] 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 12/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 62 rs: Manual st: NotStopd
t0: [12:31:00 12/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.23 rs: Final st: NotStopd t0: [12:31:00 12/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [12:31:00 12/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -6 rs: Final st: NotStopd t0: [12:31:00 12/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [12:31:00 12/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 50 u1: mmHg rs: Final st: NotStopd t0: [12:31:00 12/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 126 u1: mmHg rs: Final st: NotStopd t0: [12:31:00 12/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.23 rs: Final st: NotStopd t0: [12:31:00 12/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd
id: Labetolol el: 100 cu: MICU cg: RN io: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions am: 100 du: mgmin rt: IV Drip
tf: [16:00:00 12/05/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Labetalol HCl v1: 200 u1: mg m2: D5W v2: 200 u2: ml tf: [12:00:00 13/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 13 dn: 1 m1: Dextrose 50% v1: 12.5 u1: gm
id: .9% Normal Saline el: 1 cu: MICU cg: RN io: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions vo: 100 du: ml rt: Intravenous Push
t0: [13:00:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 24 st: NotStopd t0: [13:00:00 12/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 26.1905 u1: ml/cmH st: NotStopd t0: [13:00:00 12/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [13:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [13:00:00 12/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [13:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [13:00:00 12/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [13:00:00 12/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [13:00:00 12/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2 st: NotStopd t0: [13:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [13:00:00 12/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [13:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [13:00:00 12/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [13:00:00 12/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [13:00:00 12/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [13:00:00 12/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [13:00:00 12/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:00:00 12/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [13:00:00 12/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [13:00:00 12/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [13:00:00 12/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [13:00:00 12/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [13:00:00 12/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [13:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 95 u1: % st: NotStopd t0: [13:00:00 12/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Green v2: Thin st: NotStopd t0: [13:00:00 12/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [13:00:00 12/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 560 u1: ml/B st: NotStopd t0: [13:00:00 12/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [13:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [13:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [13:00:00 12/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [13:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [13:00:00 12/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [13:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [13:00:00 12/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [13:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 135 u1: BPM st: NotStopd t0: [13:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [13:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [13:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [13:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 12/05/2011] tf: [02:15:00 15/05/2011] dt: 3735 id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [13:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [13:00:00 12/05/2011] 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 12/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 85 rs: Manual st: NotStopd
t0: [13:00:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [13:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [13:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [13:33:00 12/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.3 rs: Final st: NotStopd t0: [13:33:00 12/05/2011] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [13:33:00 12/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -5 rs: Final st: NotStopd t0: [13:33:00 12/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [13:33:00 12/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 41 u1: mmHg rs: Final st: NotStopd t0: [13:33:00 12/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 115 u1: mmHg rs: Final st: NotStopd t0: [13:33:00 12/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.3 rs: Final st: NotStopd t0: [13:33:00 12/05/2011] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd
t0: [13:30:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:30:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 2 u1: mmHg st: NotStopd t0: [13:30:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:30:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:30:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:30:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 111 u1: BPM st: NotStopd t0: [13:30:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:30:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [13:30:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [13:30:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:30:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [13:30:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [13:30:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:30:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [13:30:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip t0: [13:30:00 12/05/2011] 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 12/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd
t0: [13:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 500 vu: ml
t0: [13:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 2 u1: mmHg st: NotStopd
t0: [13:30:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [13:30:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [13:30:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [13:30:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [13:30:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [13:30:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [13:30:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [13:30:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [13:30:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [13:30:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [14:00:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [14:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [14:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [14:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [14:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [14:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [14:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [14:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [14:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [14:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [14:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [14:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [14:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [14:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [14:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [14:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [14:00:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [14:00:00 12/05/2011] 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: [14:00:00 12/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 82 rs: Manual st: NotStopd
t0: [13:00:00 12/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [13:00:00 12/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [13:00:00 12/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 12/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 12/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [13:00:00 12/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Ultrasound st: NotStopd t0: [14:00:00 12/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [14:00:00 12/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 12/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 12/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [15:00:00 12/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [15:00:00 12/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [15:00:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [15:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [15:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 12/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 12/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [15:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [15:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [15:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [15:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [15:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [15:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [15:00:00 12/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [15:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [15:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [15:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 89 u1: % st: NotStopd t0: [15:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [15:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [15:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [15:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [15:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 12/05/2011] tf: [20:00:00 12/05/2011] dt: 420 id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml nb: 1 t0: [13:00:00 12/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [14:00:00 12/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [15:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [15:00:00 12/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 90 vu: ml t0: [15:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [15:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [15:00:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [15:00:00 12/05/2011] 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 12/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 12/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 12/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 12/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [12:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 12/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [13:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [13:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 12/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [13:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [13:00:00 12/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [13:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [13:00:00 12/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [13:00:00 12/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Fam Talked to RN st: NotStopd t0: [13:00:00 12/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [13:00:00 12/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [13:00:00 12/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [13:00:00 12/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [13:00:00 12/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [13:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [13:00:00 12/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [13:00:00 12/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [13:00:00 12/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [13:00:00 12/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 12/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [13:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [13:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 12/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [13:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [13:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [13:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [13:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [13:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [13:00:00 12/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [13:00:00 12/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [13:00:00 12/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [13:00:00 12/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [14:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [14:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 12/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 12/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [14:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [14:00:00 12/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [14:00:00 12/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [14:00:00 12/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [14:00:00 12/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 12/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [14:00:00 12/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [14:00:00 12/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [14:00:00 12/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [14:00:00 12/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [14:00:00 12/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 12/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [14:00:00 12/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [14:00:00 12/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [14:00:00 12/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 12/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 12/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 12/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [14:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [14:00:00 12/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 12/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 12/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [14:00:00 12/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 12/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 12/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 12/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [14:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 12/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 12/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 12/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [14:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [14:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 12/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 12/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 12/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [14:00:00 12/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 12/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [15:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [15:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 12/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [15:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [15:00:00 12/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [15:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [15:00:00 12/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [15:00:00 12/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [15:00:00 12/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [15:00:00 12/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [15:00:00 12/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [15:00:00 12/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [15:00:00 12/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [15:00:00 12/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [15:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [15:00:00 12/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [15:00:00 12/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [15:00:00 12/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [15:00:00 12/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [15:00:00 12/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [15:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [15:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 12/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [15:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [15:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [15:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [15:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [15:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [15:00:00 12/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [15:00:00 12/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [15:00:00 12/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [15:00:00 12/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [15:00:00 12/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [15:00:00 12/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [15:00:00 12/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Comp. Immobile st: NotStopd t0: [15:00:00 12/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [15:00:00 12/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [15:00:00 12/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 8 u1: number st: NotStopd t0: [15:00:00 12/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [15:00:00 12/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [15:00:00 12/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [15:00:00 12/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [15:00:00 12/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
tf: [15:00:00 13/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 16 dn: 1 m1: Potassium Chloride v1: 20 u1: mEq m2: SW v2: 50 u2: ml
t0: [16:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [16:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [16:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [16:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [16:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 12/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 12/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.8889 u1: Deg. C st: NotStopd t0: [16:00:00 12/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 102 u1: Deg. F st: NotStopd t0: [16:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [16:00:00 12/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 90 vu: ml t0: [16:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 130 vu: ml t0: [16:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [16:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:00:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [16:00:00 12/05/2011] 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
tf: [10:00:00 13/05/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Labetalol HCl v1: 1200 u1: mg m2: D5W v2: 300 u2: ml
t0: [17:00:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 24 st: NotStopd t0: [17:00:00 12/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 23.913 u1: ml/cmH st: NotStopd t0: [17:00:00 12/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [17:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [17:00:00 12/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [17:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [17:00:00 12/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [17:00:00 12/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [17:00:00 12/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.7 st: NotStopd t0: [17:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 12/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [17:00:00 12/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [17:00:00 12/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [17:00:00 12/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [17:00:00 12/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.4 u1: L/min st: NotStopd t0: [17:00:00 12/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 12/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT st: NotStopd t0: [17:00:00 12/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [17:00:00 12/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [17:00:00 12/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [17:00:00 12/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [17:00:00 12/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [17:00:00 12/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [17:00:00 12/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 570 u1: ml/B st: NotStopd t0: [17:00:00 12/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [17:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [17:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [17:00:00 12/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [17:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [17:00:00 12/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [17:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 12/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
id: D5W el: 1 cu: MICU cg: RN io: D5W IV Infusions du: ml rt: Intravenous Push
t0: [16:15:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:15:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:15:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:15:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:15:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:15:00 12/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: CT scan st: NotStopd t0: [16:30:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:30:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:30:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:30:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:30:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [16:30:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [16:30:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:30:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [16:45:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 95 u1: mmHg u2: mmHg st: NotStopd t0: [17:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:15:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:15:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:15:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:15:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:15:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:15:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:15:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [17:15:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:15:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 96 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [17:15:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [17:15:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:15:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [17:15:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [17:15:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:30:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:30:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:30:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:30:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:30:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:30:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:30:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [17:30:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:30:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 94 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [17:30:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [17:30:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:30:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [17:30:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:45:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:45:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:45:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:45:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:45:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:45:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:45:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [17:45:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:45:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 85 u1: mmHg v2: 40 u2: mmHg st: NotStopd t0: [17:45:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 53 u1: mmHg st: NotStopd t0: [17:45:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:45:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [17:45:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [17:45:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [18:00:00 12/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 83 u1: mmHg v2: 37 u2: mmHg st: NotStopd t0: [18:00:00 12/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 52.3333 u1: mmHg st: NotStopd t0: [18:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 92 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [18:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 58 u1: mmHg st: NotStopd t0: [18:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [18:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:15:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:15:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [16:15:00 12/05/2011] 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: [16:30:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:30:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [16:30:00 12/05/2011] 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: [16:45:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip t0: [17:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:00:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip t0: [17:00:00 12/05/2011] 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: [17:15:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:15:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip t0: [17:15:00 12/05/2011] 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: [17:30:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:30:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [17:30:00 12/05/2011] 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: [17:45:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:45:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [17:45:00 12/05/2011] 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: [18:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [18:00:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [18:00:00 12/05/2011] 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: [15:00:00 12/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [16:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [16:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [17:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [17:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [17:00:00 12/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [17:00:00 12/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [17:00:00 12/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [17:00:00 12/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [17:00:00 12/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [17:00:00 12/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [17:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [17:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [17:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [17:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [17:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [17:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [17:00:00 12/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [18:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [18:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [18:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [18:00:00 12/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 12/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [18:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [18:00:00 12/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [18:00:00 12/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [18:00:00 12/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [18:00:00 12/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [18:00:00 12/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [18:00:00 12/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [18:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [18:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [18:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: RN v1: 7.5 mm st: NotStopd t0: [18:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Endotracheal st: NotStopd t0: [18:00:00 12/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 12/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [18:00:00 12/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 12/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [18:00:00 12/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [18:00:00 12/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 12/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [18:00:00 12/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [18:00:00 12/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [18:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 12/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [18:00:00 12/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 12/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [18:00:00 12/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [18:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [18:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [18:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [18:00:00 12/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 12/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [18:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [18:00:00 12/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [18:00:00 12/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 77 rs: Manual st: NotStopd t0: [18:00:00 12/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [18:00:00 12/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [18:00:00 12/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [18:00:00 12/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd
t0: [16:00:00 12/05/2011] tf: [20:00:00 12/05/2011] dt: 240 id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml nb: 1 t0: [17:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:00:00 12/05/2011] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [17:00:00 12/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 82.5 vu: ml t0: [17:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [17:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml t0: [18:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 500 vu: ml t0: [18:00:00 12/05/2011] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [18:00:00 12/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 37.5 vu: ml t0: [18:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [18:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd
t0: [19:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 12/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd
t0: [19:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 500 vu: ml t0: [19:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml
t0: [19:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [19:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [19:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [19:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [19:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [19:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [19:00:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [19:00:00 12/05/2011] 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: [18:36:00 12/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 12.6 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 12.6 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 28.3 u1: % rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.5 u1: gm/dl rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 270 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.3 u1: /mic l rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 12.6 rs: Final st: NotStopd
t0: [18:36:00 12/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 75 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 135 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 75 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [18:36:00 12/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 135 rs: Final st: NotStopd
id: KCL el: 100 cu: MICU cg: RN io: D5W 10000.0ml IV Infusions am: 20 du: mEq rt: Intravenous Push
t0: [20:00:00 12/05/2011] id: ETT Mark/Location el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 12/05/2011] id: ETT Position Change el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 12/05/2011] id: Airway Size el: 0 cu: MICU cg: -1 st: D/C'd
io: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ra: 75 ru: ml/hr
tf: [19:00:00 19/05/2011] pt: IV Piggyback rt: IV fr: Q24H fs: 22 dn: 1 m1: Pantoprazole Sodium v1: 40 u1: mg m2: NS v2: 100 u2: ml
id: D5W el: 1 cu: MICU cg: RN io: D5W 10000.0ml IV Infusions vo: 10000 du: ml rt: Intravenous Infusion
t0: [21:00:00 12/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 24 st: NotStopd t0: [21:00:00 12/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 23.913 u1: ml/cmH st: NotStopd t0: [21:00:00 12/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [21:00:00 12/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [21:00:00 12/05/2011] id: Extubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 24 st: NotStopd t0: [21:00:00 12/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [21:00:00 12/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [21:00:00 12/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [21:00:00 12/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.7 st: NotStopd t0: [21:00:00 12/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [21:00:00 12/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [21:00:00 12/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [21:00:00 12/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [21:00:00 12/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [21:00:00 12/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.69 u1: L/min st: NotStopd t0: [21:00:00 12/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [21:00:00 12/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [21:00:00 12/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [21:00:00 12/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [21:00:00 12/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [21:00:00 12/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [21:00:00 12/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [21:00:00 12/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [21:00:00 12/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [21:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [21:00:00 12/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 560 u1: ml/B st: NotStopd t0: [21:00:00 12/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [21:00:00 12/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [21:00:00 12/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [21:00:00 12/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [21:00:00 12/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [21:00:00 12/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [21:00:00 12/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [21:00:00 12/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [20:00:00 12/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 12/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 12/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [20:00:00 12/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 12/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 12/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 12/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 12/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 12/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 12/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [20:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 12/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 12/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 12/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 12/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 12/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 12/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 12/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [20:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [20:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 12/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [20:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 12/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 12/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 12/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [20:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 12/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Pale st: NotStopd t0: [20:00:00 12/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 12/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Clammy st: NotStopd t0: [20:00:00 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [20:00:00 12/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Green v2: Loose st: NotStopd t0: [20:00:00 12/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [20:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 12/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 12/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [20:00:00 12/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [20:00:00 12/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [20:00:00 12/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 12/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 12/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 78 rs: Manual st: NotStopd t0: [20:00:00 12/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 12/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [20:00:00 12/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 12/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 12/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [21:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [21:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 12/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 12/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [21:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 12/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [21:00:00 12/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 12/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [21:00:00 12/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 12/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [21:00:00 12/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 12/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [21:00:00 12/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 12/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 12/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 12/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 12/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 12/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 12/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 92 u1: mmHg v2: 40 u2: mmHg st: NotStopd t0: [21:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 57 u1: mmHg st: NotStopd t0: [21:00:00 12/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 12/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [21:00:00 12/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 12/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [21:00:00 12/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 12/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 12/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vu: ml nb: 1 t0: [20:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [20:00:00 12/05/2011] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 150 vu: ml st: Stopped t0: [20:00:00 12/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml st: Stopped t0: [20:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [20:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml t0: [21:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [21:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [21:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [20:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [20:00:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [20:00:00 12/05/2011] 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 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [21:00:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [21:00:00 12/05/2011] 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: [22:15:00 12/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.37 rs: Final st: NotStopd t0: [22:15:00 12/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 12.7978 u1: ml/dl st: NotStopd t0: [22:15:00 12/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -3 rs: Final st: NotStopd t0: [22:15:00 12/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [22:15:00 12/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 35 u1: mmHg rs: Final st: NotStopd t0: [22:15:00 12/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 104 u1: mmHg rs: Final st: NotStopd t0: [22:15:00 12/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.37 rs: Final st: NotStopd t0: [22:15:00 12/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 98 u1: % rs: Final st: NotStopd
t0: [22:00:00 12/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 12/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [22:00:00 12/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 12/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [22:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [22:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 12/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [22:00:00 12/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [22:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 102 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [22:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [22:00:00 12/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 12/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 12/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [22:00:00 12/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 12/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 12/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 12/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 12/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [22:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 12/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 63 rs: Manual st: NotStopd
t0: [21:00:00 12/05/2011] tf: [18:00:00 13/05/2011] dt: 1260 id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vu: ml nb: 1 t0: [20:00:00 12/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Small t0: [21:00:00 12/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vu: ml t0: [21:00:00 12/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [22:00:00 12/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vu: ml nb: 1 t0: [22:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [22:00:00 12/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [22:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 12/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml t0: [22:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [22:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [22:00:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [22:00:00 12/05/2011] 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 12/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [22:00:00 12/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
tf: [22:00:00 13/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 23 dn: 1 m1: Dextrose 50% v1: 12.5 u1: gm
t0: [23:00:00 12/05/2011] tf: [08:00:00 14/05/2011] dt: 1980 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [23:00:00 12/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [23:00:00 12/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [23:00:00 12/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 12/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [23:30:00 12/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [23:30:00 12/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 13/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 13/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 2 u1: mmHg st: NotStopd t0: [00:00:00 13/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 13/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 13/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 13/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 13/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 13/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 13/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 101 u1: BPM st: NotStopd t0: [00:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 13/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 13/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 13/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [00:00:00 13/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 13/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 13/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 13/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 13/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 13/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 13/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 13/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 13/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 13/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 13/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 13/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 13/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 13/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 13/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 13/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [00:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [00:00:00 13/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 13/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 13/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 13/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 13/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 13/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [00:00:00 13/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 13/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 13/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 13/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 13/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Pale st: NotStopd t0: [00:00:00 13/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 13/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Clammy st: NotStopd t0: [00:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [00:00:00 13/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 13/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 13/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5556 u1: Deg. C st: NotStopd t0: [00:00:00 13/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.6 u1: Deg. F st: NotStopd t0: [00:00:00 13/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [00:00:00 13/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 13/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 13/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 89 rs: Manual st: NotStopd t0: [00:00:00 13/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 13/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [00:00:00 13/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 13/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 13/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [00:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [00:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [00:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [00:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [00:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [00:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [00:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [00:00:00 13/05/2011] 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 13/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [23:00:00 12/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 12/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [23:00:00 12/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 12/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 12/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 12/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 12/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 12/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [23:00:00 12/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 12/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [23:00:00 12/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [23:00:00 12/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 12/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [23:00:00 12/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 13/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 24 st: NotStopd t0: [01:00:00 13/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 21.1538 u1: ml/cmH st: NotStopd t0: [01:00:00 13/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [01:00:00 13/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [01:00:00 13/05/2011] id: Extubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 24 st: NotStopd t0: [01:00:00 13/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [01:00:00 13/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [01:00:00 13/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [01:00:00 13/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [01:00:00 13/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [01:00:00 13/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [01:00:00 13/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [01:00:00 13/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [01:00:00 13/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [01:00:00 13/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 13/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 13/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [01:00:00 13/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [01:00:00 13/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [01:00:00 13/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [01:00:00 13/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [01:00:00 13/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [01:00:00 13/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [01:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [01:00:00 13/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 545 u1: ml/B st: NotStopd t0: [01:00:00 13/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [01:00:00 13/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [01:00:00 13/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [01:00:00 13/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [01:00:00 13/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [01:00:00 13/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [01:00:00 13/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [01:00:00 13/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [23:00:00 12/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [23:00:00 12/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [23:00:00 12/05/2011] 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 12/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RRT pv: 30 cv: 30 ap: none
t0: [00:00:00 13/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 13/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 13/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 13/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 13/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:00:00 13/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 13/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 13/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 13/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 13/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [01:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [01:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [01:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [01:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [01:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [02:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [02:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [02:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [02:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [02:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 13/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [02:00:00 13/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3889 u1: Deg. C st: NotStopd t0: [02:00:00 13/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.3 u1: Deg. F st: NotStopd t0: [02:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 150 vu: ml t0: [02:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [02:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml
t0: [01:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [01:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [01:00:00 13/05/2011] 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 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [02:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [02:00:00 13/05/2011] 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 13/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 78 rs: Manual st: NotStopd
t0: [03:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 1 u1: mmHg st: NotStopd t0: [03:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [03:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [03:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [03:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [03:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [03:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [03:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [03:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [03:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [03:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [03:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [03:00:00 13/05/2011] 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 13/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 210 cv: 210 ap: none t0: [23:00:00 13/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -157 cv: -157 ap: none t0: [23:00:00 13/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 13 cv: 2862.05 ap: none t0: [23:00:00 13/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 53 cv: 4127.05 ap: none t0: [23:00:00 13/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 40 cv: 830 ap: none t0: [23:00:00 13/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 210 cv: 1510 ap: none t0: [23:00:00 13/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -157 cv: 2617.05 ap: none t0: [23:00:00 13/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 210 cv: 1510 ap: none t0: [23:00:00 13/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -157 cv: 26303.8 ap: carryForward
t0: [00:00:00 13/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 13/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [02:00:00 13/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 3 u1: mmHg st: NotStopd t0: [04:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 13/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [04:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [04:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [04:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [04:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [04:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [04:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [04:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml t0: [04:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [04:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [04:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [04:00:00 13/05/2011] 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: [04:12:00 13/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd t0: [04:12:00 13/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -4 rs: Final st: NotStopd t0: [04:12:00 13/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [04:12:00 13/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 37 u1: mmHg rs: Final st: NotStopd t0: [04:12:00 13/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 102 u1: mmHg rs: Final st: NotStopd t0: [04:12:00 13/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd
t0: [00:00:00 13/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 13/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [00:00:00 13/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [00:00:00 13/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [02:00:00 13/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [02:00:00 13/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 13/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 13/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [02:00:00 13/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [02:00:00 13/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [02:00:00 13/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 13/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 13/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 13/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 13/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 13/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 13/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 13/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 13/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 13/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 13/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 13/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 13/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 13/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 13/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [04:00:00 13/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 13/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [04:00:00 13/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 13/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [04:00:00 13/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [04:00:00 13/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 13/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 13/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 13/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 13/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 13/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 13/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [04:00:00 13/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 13/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 13/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 13/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 13/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 13/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 13/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 13/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 13/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 13/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 13/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 13/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 13/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 13/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [04:00:00 13/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 13/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 13/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 13/05/2011] 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 13/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 13/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 13/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 13/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 13/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 13/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 13/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 13/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 13/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 13/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Pale st: NotStopd t0: [04:00:00 13/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 13/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Clammy st: NotStopd t0: [04:00:00 13/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [04:00:00 13/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 13/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 13/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 13/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.9444 u1: Deg. C st: NotStopd t0: [04:00:00 13/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.3 u1: Deg. F st: NotStopd t0: [04:00:00 13/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [04:00:00 13/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 13/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 13/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 103 rs: Manual st: NotStopd t0: [04:00:00 13/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [04:00:00 13/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [04:00:00 13/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 13/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [04:00:00 13/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [04:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml
t0: [04:35:00 13/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 32.3529 u1: ml/cmH st: NotStopd t0: [04:35:00 13/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 128.889 u1: units st: NotStopd t0: [04:35:00 13/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 20 t0: [04:35:00 13/05/2011] id: Extubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 24 st: NotStopd t0: [04:35:00 13/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:35:00 13/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:35:00 13/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [04:35:00 13/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:35:00 13/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:35:00 13/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [04:35:00 13/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [04:35:00 13/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [04:35:00 13/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 15.1 u1: L/min st: NotStopd t0: [04:35:00 13/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:35:00 13/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:35:00 13/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [04:35:00 13/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [04:35:00 13/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 128.889 u1: units st: NotStopd t0: [04:35:00 13/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 9 u1: BPM st: NotStopd t0: [04:35:00 13/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [04:35:00 13/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [04:35:00 13/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:35:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [04:35:00 13/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [04:35:00 13/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.225 u1: L st: NotStopd t0: [04:35:00 13/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 580 u1: ml/B st: NotStopd t0: [04:35:00 13/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [04:35:00 13/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:35:00 13/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:35:00 13/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 13/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 13/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 13/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 13/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 13/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 13/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 13/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 13/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 13/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 13/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [04:00:00 13/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 13/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [05:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 130 u1: BPM st: NotStopd t0: [05:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [05:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [05:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [05:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [05:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [05:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [05:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [05:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [05:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [05:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [05:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [05:00:00 13/05/2011] 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 13/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.4 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 9.4 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 27.4 u1: % rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.2 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 249 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.19 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.4 rs: Final st: NotStopd
t0: [04:00:00 13/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 6.9 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 100 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 135 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 6.9 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 100 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [04:00:00 13/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 135 rs: Final st: NotStopd
id: KCL el: 100 cu: MICU cg: RN io: D5W 50.0ml IV Infusions am: 20 du: mEq rt: Intravenous Push
id: D5W el: 1 cu: MICU cg: RN io: D5W 50.0ml IV Infusions vo: 50 du: ml rt: Intravenous Push
t0: [06:00:00 13/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [06:00:00 13/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [06:00:00 13/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 13/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [06:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [06:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 13/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [06:00:00 13/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [06:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 93 u1: mmHg v2: 40 u2: mmHg st: NotStopd t0: [06:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 56 u1: mmHg st: NotStopd t0: [06:00:00 13/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 13/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 13/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [06:00:00 13/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 13/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 13/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 13/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 13/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [06:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [06:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [06:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [06:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [06:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [06:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [06:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [06:00:00 13/05/2011] 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 12/05/2011] id: SpO2 el: 0 cu: MICU cg: RN u1: % st: NotStopd
t0: [06:45:00 13/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 250 vu: ml t0: [06:45:00 13/05/2011] tf: [21:00:00 19/05/2011] dt: 9495 id: D5W 50.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 1878 vo: 50 vu: ml
tf: [06:00:00 14/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 7 dn: 1 m1: Magnesium Sulfate v1: 4 u1: gm m2: NS v2: 250 u2: ml tf: [06:00:00 14/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 7 dn: 1 m1: Potassium Chloride v1: 20 u1: mEq m2: SW v2: 50 u2: ml
t0: [08:00:00 13/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 13/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [08:00:00 13/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 13/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 13/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 13/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 13/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Weak Palpable st: NotStopd t0: [08:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 13/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 13/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [08:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 13/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 13/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [08:00:00 13/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [08:00:00 13/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 13/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 13/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 13/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [08:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 13/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 13/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [08:00:00 13/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 13/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 13/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 13/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 13/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 13/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 13/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 13/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 13/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 13/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 13/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Lethargic st: NotStopd t0: [08:00:00 13/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 13/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 13/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 87 u1: mmHg v2: 39 u2: mmHg st: NotStopd t0: [08:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 54 u1: mmHg st: NotStopd t0: [08:00:00 13/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 13/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [08:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 13/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 13/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 13/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 13/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 13/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [08:00:00 13/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 13/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 13/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 13/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 13/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 13/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool st: NotStopd t0: [08:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 13/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 13/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.1111 u1: Deg. C st: NotStopd t0: [08:00:00 13/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.6 u1: Deg. F st: NotStopd t0: [08:00:00 13/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Cloudy st: NotStopd t0: [08:00:00 13/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 13/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 13/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [08:00:00 13/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [08:00:00 13/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 13/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Positive st: NotStopd t0: [08:00:00 13/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [08:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 13/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [08:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 150 vu: ml t0: [08:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [08:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml
t0: [08:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [08:00:00 13/05/2011] 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 13/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 60 ap: none
t0: [09:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [09:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [09:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 83 u1: mmHg v2: 37 u2: mmHg st: NotStopd t0: [09:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 52 u1: mmHg st: NotStopd t0: [09:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [09:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [09:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [09:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [09:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [09:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [09:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [09:00:00 13/05/2011] 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 13/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 st: NotStopd t0: [09:00:00 13/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 23.913 u1: ml/cmH st: NotStopd t0: [09:00:00 13/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [09:00:00 13/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [09:00:00 13/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [09:00:00 13/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [09:00:00 13/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.7 st: NotStopd t0: [09:00:00 13/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [09:00:00 13/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [09:00:00 13/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [09:00:00 13/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [09:00:00 13/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [09:00:00 13/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.61 u1: L/min st: NotStopd t0: [09:00:00 13/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [09:00:00 13/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [09:00:00 13/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [09:00:00 13/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [09:00:00 13/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [09:00:00 13/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [09:00:00 13/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [09:00:00 13/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [09:00:00 13/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [09:00:00 13/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [09:00:00 13/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 534 u1: ml/B st: NotStopd t0: [09:00:00 13/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [09:00:00 13/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [09:00:00 13/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [09:00:00 13/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 13/05/2011] id: Vancomycin/Random Drug Level el: 0 cu: MICU cg: 1663 v1: 11.2 rs: Final st: NotStopd
t0: [09:45:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:45:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [09:45:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:45:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:45:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:45:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:45:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:45:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [09:45:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:45:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 79 u1: mmHg v2: 36 u2: mmHg st: NotStopd t0: [09:45:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 51 u1: mmHg st: NotStopd t0: [09:45:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:45:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [09:45:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [09:45:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:45:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:45:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [09:45:00 13/05/2011] 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
tf: [10:00:00 19/05/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Prednisone v1: 60 u1: mg
t0: [10:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [10:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [10:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 72 u1: mmHg v2: 36 u2: mmHg st: NotStopd t0: [10:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 49 u1: mmHg st: NotStopd t0: [10:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [10:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [10:00:00 13/05/2011] 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: [10:15:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:15:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [10:15:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:15:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:15:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:15:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:15:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:15:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [10:15:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:15:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 69 u1: mmHg v2: 35 u2: mmHg st: NotStopd t0: [10:15:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 48 u1: mmHg st: NotStopd t0: [10:15:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:15:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [10:15:00 13/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [10:15:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:15:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:15:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:15:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [10:15:00 13/05/2011] 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: [10:15:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 37.5 vu: ml t0: [10:15:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 500 vu: ml t0: [10:15:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 93.75 vu: ml t0: [10:15:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.25 vu: ml t0: [10:15:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3.75 vu: ml
tf: [10:00:00 14/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Dexamethasone v1: 4 u1: mg
t0: [11:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [11:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [11:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 79 u1: mmHg v2: 40 u2: mmHg st: NotStopd t0: [11:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 55 u1: mmHg st: NotStopd t0: [11:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [11:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [11:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:15:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:15:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [11:15:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:15:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:15:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:15:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:15:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:15:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 118 u1: BPM st: NotStopd t0: [11:15:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:15:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 86 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [11:15:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [11:15:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:15:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [11:15:00 13/05/2011] id: Significant Events el: 0 cu: MICU cg: RN v1: Fluid Bolus st: NotStopd t0: [11:15:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [11:15:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [11:00:00 13/05/2011] 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: [11:15:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:15:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [11:15:00 13/05/2011] 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: [11:30:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:30:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [11:30:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:30:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [11:30:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:30:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 88 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [11:30:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [11:30:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:30:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [11:30:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [11:30:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:30:00 13/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 135 rs: Manual st: NotStopd
t0: [11:30:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:30:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [11:30:00 13/05/2011] 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
id: Levophed-k el: 300 cu: MICU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions am: 4 du: mcgkgmin rt: IV Drip
io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 3 cu: MICU cg: RN ra: 4.347 ru: ml/hr
tf: [10:00:00 14/05/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Norepinephrine v1: 4 u1: mg m2: D5W v2: 250 u2: ml
id: D5W el: 3 cu: MICU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [12:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [12:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 103 u1: BPM st: NotStopd t0: [12:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [12:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [12:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [12:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [12:00:00 13/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 13/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [12:00:00 13/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [12:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 52.5 vu: ml t0: [12:00:00 13/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 3 cu: MICU cg: RN ai: 189 vo: 0 vu: ml nb: 1 t0: [12:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 8.75 vu: ml t0: [12:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 180 vu: ml t0: [12:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 5.25 vu: ml
t0: [12:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 45 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:00:00 13/05/2011] tf: [20:00:00 13/05/2011] dt: 480 id: Levophed-k el: 3 cu: MICU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [12:00:00 13/05/2011] 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 13/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 26.1905 u1: ml/cmH st: NotStopd t0: [13:00:00 13/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 18 t0: [13:00:00 13/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [13:00:00 13/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [13:00:00 13/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [13:00:00 13/05/2011] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.7 st: NotStopd t0: [13:00:00 13/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [13:00:00 13/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [13:00:00 13/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [13:00:00 13/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [13:00:00 13/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [13:00:00 13/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.3 u1: L/min st: NotStopd t0: [13:00:00 13/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:00:00 13/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [13:00:00 13/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [13:00:00 13/05/2011] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [13:00:00 13/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [13:00:00 13/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [13:00:00 13/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [13:00:00 13/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [13:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 95 u1: % st: NotStopd t0: [13:00:00 13/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [13:00:00 13/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [13:00:00 13/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 542 u1: ml/B st: NotStopd t0: [13:00:00 13/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [13:00:00 13/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [13:00:00 13/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [13:00:00 13/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [13:49:00 13/05/2011] id: Blood Products Hematology el: 0 cu: MICU cg: 1663 v1: Y rs: Final st: NotStopd
t0: [13:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [13:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [13:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [13:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [13:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [13:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [14:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [14:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [14:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [14:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [14:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [14:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [15:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [15:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [15:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [15:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [15:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [15:00:00 13/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [15:00:00 13/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [15:00:00 13/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [15:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 500 vu: ml
t0: [13:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 45 du: mcghr sv: 250 su: ml rt: IV Drip t0: [13:00:00 13/05/2011] id: Levophed-k el: 3 cu: MICU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [13:00:00 13/05/2011] 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: [14:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 45 du: mcghr sv: 250 su: ml rt: IV Drip t0: [14:00:00 13/05/2011] id: Levophed-k el: 3 cu: MICU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [14:00:00 13/05/2011] 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: [15:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 45 du: mcghr sv: 250 su: ml rt: IV Drip t0: [15:00:00 13/05/2011] id: Levophed-k el: 3 cu: MICU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [15:00:00 13/05/2011] 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: [15:00:00 13/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [15:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 90 vu: ml t0: [15:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 15 vu: ml t0: [15:00:00 13/05/2011] tf: [20:00:00 13/05/2011] dt: 300 id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 3 cu: MICU cg: RN ai: 189 vo: 13.041 vu: ml t0: [15:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 13.5 vu: ml t0: [15:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 260 vu: ml t0: [15:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 9 vu: ml
t0: [15:00:00 13/05/2011] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: 109 vo: 0 vu: ml nb: 1
t0: [15:08:00 13/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 13 t0: [15:08:00 13/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [15:08:00 13/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [15:08:00 13/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [15:08:00 13/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [15:08:00 13/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [15:08:00 13/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v2: 12 st: NotStopd t0: [15:08:00 13/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 3 st: NotStopd t0: [15:08:00 13/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [15:08:00 13/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 5.35 u1: L/min st: NotStopd t0: [15:08:00 13/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [15:08:00 13/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [15:08:00 13/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [15:08:00 13/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [15:08:00 13/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [15:08:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [15:08:00 13/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 535 u1: ml/B st: NotStopd t0: [15:08:00 13/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [15:08:00 13/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [15:08:00 13/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [15:14:00 13/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [15:14:00 13/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [15:14:00 13/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd
t0: [16:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [16:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [16:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [16:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [16:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [16:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [16:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [16:00:00 13/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 3 cu: MICU cg: RN ai: 189 vo: 4.347 vu: ml t0: [16:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4.5 vu: ml t0: [16:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [16:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [16:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 30 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:00:00 13/05/2011] id: Levophed-k el: 3 cu: MICU cg: RN so: D5W vo: 0 v1: 0.016 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [16:00:00 13/05/2011] 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 13/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 13/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.9444 u1: Deg. C st: NotStopd t0: [16:00:00 13/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.5 u1: Deg. F st: NotStopd
t0: [16:28:00 13/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.33 rs: Final st: NotStopd t0: [16:28:00 13/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.33 rs: Final st: NotStopd t0: [16:28:00 13/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd
t0: [16:00:00 13/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [17:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [17:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 99 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [17:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [17:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [17:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [17:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 30 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:00:00 13/05/2011] id: Levophed-k el: 3 cu: MICU cg: RN so: D5W vo: 0 v1: 0.016 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [17:00:00 13/05/2011] 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: [16:28:00 13/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -4 rs: Final st: NotStopd t0: [16:28:00 13/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [16:28:00 13/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 40 u1: mmHg rs: Final st: NotStopd t0: [16:28:00 13/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 118 u1: mmHg rs: Final st: NotStopd
t0: [18:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [18:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [18:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [18:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [18:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [18:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 30 du: mcghr sv: 250 su: ml rt: IV Drip t0: [18:00:00 13/05/2011] id: Levophed-k el: 3 cu: MICU cg: RN so: D5W vo: 0 v1: 0.016 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [18:00:00 13/05/2011] 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: [18:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: -1 ai: 189 vo: 0 st: D/C'd
t0: [18:00:00 13/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 195 rs: Manual st: NotStopd
t0: [12:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vu: ml t0: [15:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vu: ml t0: [16:00:00 13/05/2011] id: D5W 10000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vu: ml t0: [18:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [18:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 13/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 3 cu: MICU cg: RN ai: 189 vo: 6.9552 vu: ml t0: [18:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6 vu: ml t0: [18:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 165 vu: ml t0: [18:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml
t0: [20:00:00 13/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 13 t0: [20:00:00 13/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 13/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:00:00 13/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:00:00 13/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 13/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 13/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v2: 12 st: NotStopd t0: [20:00:00 13/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 3 st: NotStopd t0: [20:00:00 13/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:00:00 13/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [20:00:00 13/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 6.7 u1: L/min st: NotStopd t0: [20:00:00 13/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 13/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 13/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [20:00:00 13/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [20:00:00 13/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [20:00:00 13/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 650 u1: ml/B st: NotStopd t0: [20:00:00 13/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 13/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [19:30:00 13/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.2 u1: mg/dl rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 192 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 u1: mEq/L rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 135 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.2 u1: mg/dl rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 192 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 u1: mEq/L rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [19:30:00 13/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 135 rs: Final st: NotStopd
t0: [21:00:00 13/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd
t0: [20:00:00 13/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 13/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 13/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 13/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 13/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 13/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 13/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 13/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [20:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 13/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 13/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [20:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 13/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 13/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [20:00:00 13/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 13/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [20:00:00 13/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 13/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 13/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 13/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 130 u1: BPM st: NotStopd t0: [20:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 13/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 13/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 13/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [20:00:00 13/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 13/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 13/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 13/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 13/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 13/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 13/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 13/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 13/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 13/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 13/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 13/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 13/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 13/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 13/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 13/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [20:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [20:00:00 13/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 13/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [20:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 13/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 13/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 13/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 13/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 13/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [20:00:00 13/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 13/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 13/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 13/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 13/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 13/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 13/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Clammy st: NotStopd t0: [20:00:00 13/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 13/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [20:00:00 13/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [20:00:00 13/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [20:00:00 13/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 13/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 13/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 13/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [20:00:00 13/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 13/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 13/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [21:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 13/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 103 u1: BPM st: NotStopd t0: [21:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 95 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [21:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [21:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 11 u1: BPM st: NotStopd t0: [21:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [21:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 80 vu: ml t0: [20:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 13/05/2011] tf: [16:00:00 21/05/2011] dt: 11280 id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: 109 vo: 375 vu: ml t0: [20:00:00 13/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 3 cu: MICU cg: RN ai: 189 vo: 6.9552 vu: ml st: Stopped t0: [20:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6 vu: ml t0: [20:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml t0: [21:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [21:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [21:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [20:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [20:00:00 13/05/2011] id: Levophed-k el: 3 cu: MICU cg: RN so: D5W vo: 0 v1: 0.016 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped t0: [20:00:00 13/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mgmin sv: 100 su: ml rt: IV Drip t0: [20:00:00 13/05/2011] 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 13/05/2011] 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 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 13 u1: mmHg st: NotStopd
t0: [21:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip
t0: [22:05:00 13/05/2011] id: Blood Products Hematology el: 0 cu: MICU cg: 1663 v1: Y rs: Final st: NotStopd
t0: [22:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [22:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [22:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 102 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [22:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [22:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 13 u1: BPM st: NotStopd t0: [22:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [22:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 13/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 13/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 13/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [23:00:00 13/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 13/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 13/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 13/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 13/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [23:00:00 13/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 13/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [23:00:00 13/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 109 u1: mmHg st: NotStopd t0: [23:00:00 13/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 13/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [23:00:00 13/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [23:00:00 13/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [23:00:00 13/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [23:00:00 13/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [23:00:00 13/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [22:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [22:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml t0: [23:00:00 13/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [23:00:00 13/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [23:00:00 13/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 210 vu: ml t0: [23:00:00 13/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [22:00:00 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [22:00:00 13/05/2011] 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 13/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [23:00:00 13/05/2011] 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 13/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 13/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 13/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 13/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 13/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 13/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 13/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 13/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 13/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 13/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 13/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 13/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [20:00:00 13/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 13/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 13/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [21:00:00 13/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [22:00:00 13/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 13/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 13/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 13/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [22:00:00 13/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [22:00:00 13/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [22:00:00 13/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 13/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 13/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 13/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 13/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 13/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 13/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 13/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [23:00:00 13/05/2011] id: CVP el: 0 cu: MICU cg: RN u1: mmHg st: NotStopd t0: [23:00:00 13/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [23:00:00 13/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 14/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 14/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [00:00:00 14/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 14/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 14/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 14/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 14/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: RN v1: 140 rs: Manual st: NotStopd t0: [00:00:00 14/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 14/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [00:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 14/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 14/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [00:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 14/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 14/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 14/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 14/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [00:00:00 14/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 14/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 14/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 14/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 14/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 101 u1: BPM st: NotStopd t0: [00:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 14/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 14/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 14/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [00:00:00 14/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 14/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 14/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 14/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 14/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 14/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 14/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 14/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 14/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 14/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 14/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 14/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 14/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 14/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 14/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 14/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 14/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 14/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 14/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 14/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [00:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [00:00:00 14/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 14/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 14/05/2011] 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 14/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 14/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 14/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 14/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 14/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 14/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [00:00:00 14/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 14/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 14/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 14/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 14/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 14/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [00:00:00 14/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 14/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Clammy st: NotStopd t0: [00:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [00:00:00 14/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Green v2: Loose st: NotStopd t0: [00:00:00 14/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 14/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 14/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 14/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [00:00:00 14/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 14/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 14/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 14/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 14/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: RN v1: 140 rs: Manual st: NotStopd t0: [00:00:00 14/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [00:00:00 14/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 14/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 14/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [20:00:00 13/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [21:00:00 13/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [23:00:00 13/05/2011] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: 109 vu: ml nb: 1 t0: [00:00:00 14/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [00:00:00 14/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [00:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [00:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [00:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [21:00:00 13/05/2011] tf: [14:07:00 24/05/2011] dt: 15427 id: Levophed-k el: 3 cu: MICU cg: RN so: D5W vo: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 13/05/2011] id: Levophed-k el: 3 cu: MICU cg: RN so: D5W vo: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 13/05/2011] id: Levophed-k el: 3 cu: MICU cg: RN so: D5W vo: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [00:00:00 14/05/2011] 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 13/05/2011] dt: 24 id: Blood Products Total el: 2 cu: MICU cg: RN cv: 375 ap: none
t0: [00:00:00 14/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 13 t0: [00:00:00 14/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 14/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [00:00:00 14/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [00:00:00 14/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 14/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 14/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 3 st: NotStopd t0: [00:00:00 14/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [00:00:00 14/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [00:00:00 14/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.1 u1: L/min st: NotStopd t0: [00:00:00 14/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 14/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 14/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [00:00:00 14/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 12 u1: BPM st: NotStopd t0: [00:00:00 14/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 14/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 699 u1: ml/B st: NotStopd t0: [00:00:00 14/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 14/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [01:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [01:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [01:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [01:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [01:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [01:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 14/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [01:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [01:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [01:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [01:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [01:00:00 14/05/2011] 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 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [02:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [02:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [02:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 10 u1: BPM st: NotStopd t0: [02:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [02:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 14/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [02:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [02:00:00 14/05/2011] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: 109 vo: 375 vu: ml t0: [02:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml t0: [02:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [02:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [02:00:00 14/05/2011] 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 14/05/2011] dt: 24 id: Blood Products Total el: 2 cu: MICU cg: RN cv: 375 ap: none
t0: [02:00:00 14/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [02:00:00 14/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 14/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 14/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [02:00:00 14/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [02:00:00 14/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [02:00:00 14/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 14/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 14/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 14/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 14/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 14/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 14/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 14/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [03:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [03:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [03:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [03:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [03:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 11 u1: BPM st: NotStopd t0: [03:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [03:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 14/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [03:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [03:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [03:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [03:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [03:00:00 14/05/2011] 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: [03:31:00 14/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.31 rs: Final st: NotStopd t0: [03:31:00 14/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -3 rs: Final st: NotStopd t0: [03:31:00 14/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 24 rs: Final st: NotStopd t0: [03:31:00 14/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [03:31:00 14/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 116 u1: mmHg rs: Final st: NotStopd t0: [03:31:00 14/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.31 rs: Final st: NotStopd
t0: [03:30:00 14/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 8 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 34.1 u1: % rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 11.4 u1: gm/dl rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 207 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.87 u1: /mic l rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8 rs: Final st: NotStopd
t0: [03:30:00 14/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 161 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 u1: mEq/L rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 161 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 u1: mEq/L rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [03:30:00 14/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd
t0: [04:00:00 14/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [04:00:00 14/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 14/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 14/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [04:00:00 14/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 14/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [04:30:00 14/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 28.9256 u1: units st: NotStopd t0: [04:30:00 14/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 28.9256 u1: units st: NotStopd t0: [04:30:00 14/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [04:30:00 14/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.484 u1: L st: NotStopd t0: [04:40:00 14/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 13 t0: [04:40:00 14/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:40:00 14/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:40:00 14/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [04:40:00 14/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:40:00 14/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:40:00 14/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 3 st: NotStopd t0: [04:40:00 14/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:40:00 14/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [04:40:00 14/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 6.5 u1: L/min st: NotStopd t0: [04:40:00 14/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:40:00 14/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:40:00 14/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [04:40:00 14/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [04:40:00 14/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:40:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [04:40:00 14/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 615 u1: ml/B st: NotStopd t0: [04:40:00 14/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:40:00 14/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [05:00:00 14/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [05:00:00 14/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [05:00:00 14/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 14/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [05:00:00 14/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [05:00:00 14/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 534 u1: ml/B st: NotStopd t0: [05:00:00 14/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [05:00:00 14/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd
t0: [04:00:00 14/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 14/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [04:00:00 14/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 14/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [04:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 14/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 14/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 14/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [04:00:00 14/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 14/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 14/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 14/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 14/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 14/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 14/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 14/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 14/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [04:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [04:00:00 14/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 14/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 14/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 11 u1: BPM st: NotStopd t0: [04:00:00 14/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 14/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 14/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 14/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 14/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [04:00:00 14/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 14/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Clammy st: NotStopd t0: [04:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [04:00:00 14/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [05:00:00 14/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [05:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 14/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 14/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [05:00:00 14/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [05:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 14/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [05:00:00 14/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [05:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 14/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [05:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 14/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [05:00:00 14/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [05:00:00 14/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [05:00:00 14/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [05:00:00 14/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [05:00:00 14/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [05:00:00 14/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [05:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [05:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 14/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [05:00:00 14/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [05:00:00 14/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 14/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [05:00:00 14/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [05:00:00 14/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [05:00:00 14/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [05:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [05:00:00 14/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [05:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 14/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [05:00:00 14/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 14/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [05:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [05:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [05:00:00 14/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [05:00:00 14/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [05:00:00 14/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [05:00:00 14/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [05:00:00 14/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 14/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [05:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 14/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [05:00:00 14/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [05:00:00 14/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 14/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [05:00:00 14/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [05:00:00 14/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 100 vu: ml t0: [05:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [05:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml
t0: [04:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [04:00:00 14/05/2011] 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 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [05:00:00 14/05/2011] 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: [05:15:00 14/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd
t0: [06:00:00 14/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [06:00:00 14/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [06:00:00 14/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 14/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [06:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 116 u1: BPM st: NotStopd t0: [06:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 14/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [06:00:00 14/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [06:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [06:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [06:00:00 14/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 14/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 14/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [06:00:00 14/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 14/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 14/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 14/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [06:00:00 14/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [06:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 14/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 50 vu: ml t0: [06:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [06:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml t0: [06:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [06:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [06:00:00 14/05/2011] 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 14/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [03:00:00 14/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 14/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 14/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:00:00 14/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [03:00:00 14/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:00:00 14/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [03:00:00 14/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [03:00:00 14/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [03:00:00 14/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [03:00:00 14/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [03:00:00 14/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 14/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [06:00:00 14/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 14/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 14/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 14/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [06:00:00 14/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 14/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 14/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [06:00:00 14/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [06:00:00 14/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [06:00:00 14/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [06:00:00 14/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [20:00:00 13/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [06:00:00 14/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml
t0: [06:00:00 14/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: RN v1: 163 rs: Manual st: NotStopd t0: [06:00:00 14/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: RN v1: 163 rs: Manual st: NotStopd
t0: [07:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [07:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [07:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [07:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [07:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 11 u1: BPM st: NotStopd t0: [07:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [07:00:00 14/05/2011] 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 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [08:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 14/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 14/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [08:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 14/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 14/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 14/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [08:00:00 14/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 14/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 14/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 14/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 14/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 14/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 14/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [08:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [08:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 14/05/2011] id: Previous Weight el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [08:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [08:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [08:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 14/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 14/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [08:00:00 14/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [08:00:00 14/05/2011] id: BSA - English el: 0 cu: MICU cg: RN v1: 0.439056 u1: m2 st: NotStopd t0: [08:00:00 14/05/2011] id: BSA - Metric el: 0 cu: MICU cg: RN v1: 0.512576 u1: m2 st: NotStopd t0: [08:00:00 14/05/2011] id: Weight Change el: 0 cu: MICU cg: RN v1: 0 u1: kg st: NotStopd t0: [08:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 14/05/2011] id: Daily Weight el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd
t0: [08:00:00 14/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [08:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 14/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [08:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [08:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml
t0: [08:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:00:00 14/05/2011] 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 14/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [08:00:00 14/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 14/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14.5 t0: [08:00:00 14/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 14/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:00:00 14/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [08:00:00 14/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 14/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.4 u1: Deg. C st: NotStopd t0: [08:00:00 14/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v2: 12 st: NotStopd t0: [08:00:00 14/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [08:00:00 14/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [08:00:00 14/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [08:00:00 14/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.5 u1: L/min st: NotStopd t0: [08:00:00 14/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 14/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 14/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [08:00:00 14/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [08:00:00 14/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:00:00 14/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [08:00:00 14/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 14/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 583 u1: ml/B st: NotStopd t0: [08:00:00 14/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 14/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [08:00:00 14/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 14/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [08:00:00 14/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [08:00:00 14/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 14/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 14/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 14/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 14/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Grimace Scale st: NotStopd t0: [08:00:00 14/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 14/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 14/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [08:00:00 14/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 14/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 14/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 14/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 14/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 14/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 14/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [08:00:00 14/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 14/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 14/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [08:00:00 14/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 14/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 14/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 14/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 14/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 14/05/2011] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [08:00:00 14/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [08:00:00 14/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 14/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serous v2: Scant st: NotStopd t0: [08:00:00 14/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [08:00:00 14/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [08:00:00 14/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 14/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 14/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 14/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 14/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 14/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 14/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 14/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 14/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 14/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [08:00:00 14/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 14/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 14/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 14/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 14/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 14/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 14/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 14/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 14/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 14/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 14/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 14/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 14/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [08:00:00 14/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [08:00:00 14/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 14/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 14/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:00:00 14/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 14/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 14/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [08:00:00 14/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 14/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 14/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 14/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 14/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 14/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 14/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [08:00:00 14/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 14/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 14/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [08:00:00 14/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 14/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 14/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [09:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [09:00:00 14/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [09:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 14/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 14/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [09:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 132 u1: BPM st: NotStopd t0: [09:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 14/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 14/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [09:00:00 14/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 14/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 171 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [09:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 121 u1: mmHg st: NotStopd t0: [09:00:00 14/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [09:00:00 14/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [09:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [09:00:00 14/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [09:00:00 14/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Frothy st: NotStopd t0: [09:00:00 14/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [09:00:00 14/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [09:00:00 14/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [09:00:00 14/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 14/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [10:00:00 14/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [10:00:00 14/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 14/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [10:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 14/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 14/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 14/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 14/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 14/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 14/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 14/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 14/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 14/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd
t0: [08:00:00 14/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 100 vu: ml st: Stopped t0: [09:00:00 14/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Medium t0: [10:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [10:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 150 vu: ml t0: [10:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 6 vu: ml
t0: [09:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:00:00 14/05/2011] 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: [10:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:00:00 14/05/2011] 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 14/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [10:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [10:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [10:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 165 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [10:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [10:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [10:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 11 u1: BPM st: NotStopd t0: [10:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [11:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [11:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 168 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [11:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 124 u1: mmHg st: NotStopd t0: [11:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [11:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [11:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [11:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [11:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 135 vu: ml t0: [11:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 3 vu: ml
t0: [11:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:00:00 14/05/2011] 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 15/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Furosemide v1: 20 u1: mg tf: [23:00:00 16/05/2011] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Furosemide v1: 100 u1: mg m2: D5W v2: 50 u2: ml
t0: [12:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [12:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 14/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: RN v1: 121 rs: Manual st: NotStopd t0: [12:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 14/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 14/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [12:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 185 u1: mmHg v2: 96 u2: mmHg st: NotStopd t0: [12:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 133 u1: mmHg st: NotStopd t0: [12:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [12:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [12:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 14/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 14/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [12:00:00 14/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [12:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 14/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: RN v1: 121 rs: Manual st: NotStopd
t0: [12:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [12:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 14/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 45 vu: ml t0: [12:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 435 vu: ml t0: [12:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [12:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:00:00 14/05/2011] 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 14/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 45 ap: none
id: Lasix el: 100 cu: MICU cg: RN io: D5W 100.0ml + 100mghr Lasix Tube Feeding am: 100 du: mghr rt: IV Drip id: Lasix el: 100 cu: MICU cg: RN io: D5W 50.0ml + 100mghr Lasix IV Infusions am: 100 du: mghr rt: IV Drip id: Lasix el: 101 cu: MICU cg: RN io: D5W 100.0ml + 100mghr Lasix Tube Feeding am: 100 du: mghr rt: IV Drip id: Lasix el: 101 cu: MICU cg: RN io: D5W 50.0ml + 100mghr Lasix IV Infusions am: 100 du: mghr rt: IV Drip
t0: [10:00:00 14/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 14/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [12:00:00 14/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 14/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 14/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 14/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [12:00:00 14/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 14/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 14/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 14/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 14/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 14/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 14/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 14/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 14/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 14/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [12:00:00 14/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 14/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 14/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [12:00:00 14/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 14/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 14/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 14/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 14/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [12:00:00 14/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 14/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [12:00:00 14/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 14/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 14/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 14/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [12:00:00 14/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 14/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 14/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 14/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 14/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [12:00:00 14/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 14/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 14/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 14/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 14/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [12:00:00 14/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 14/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 14/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [12:00:00 14/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 14/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 14/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 14/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 14/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 14/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 14/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 14/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Pale st: NotStopd t0: [12:00:00 14/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 14/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [12:00:00 14/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 14/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [12:00:00 14/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 14/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 14/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 14/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 14/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
tf: [11:00:00 15/05/2011] pt: Unit Dose rt: IV fr: ONCE MR1 fs: 12 dn: 1 m1: Metoprolol v1: 5 u1: mg
id: D5W el: 1 cu: MICU cg: RN io: D5W 100.0ml + 100mghr Lasix Tube Feeding vo: 100 du: ml rt: Intravenous Push id: D5W el: 1 cu: MICU cg: RN io: D5W 50.0ml + 100mghr Lasix IV Infusions vo: 100 du: ml rt: Intravenous Push
t0: [12:00:00 14/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [12:00:00 14/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:00:00 14/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14.5 t0: [12:00:00 14/05/2011] id: Extubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [12:00:00 14/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 14/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:00:00 14/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [12:00:00 14/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 14/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 14/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [12:00:00 14/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [12:00:00 14/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [12:00:00 14/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [12:00:00 14/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.64 u1: L/min st: NotStopd t0: [12:00:00 14/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 14/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 14/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [12:00:00 14/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 11 u1: BPM st: NotStopd t0: [12:00:00 14/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [12:00:00 14/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Bloody v2: Frothy st: NotStopd t0: [12:00:00 14/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [12:00:00 14/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 694 u1: ml/B st: NotStopd t0: [12:00:00 14/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:00:00 14/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [12:00:00 14/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:00:00 14/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [12:00:00 14/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:00:00 14/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [12:45:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:45:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:45:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:45:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:45:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:45:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:45:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [12:45:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:45:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 168 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [12:45:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 122 u1: mmHg st: NotStopd t0: [12:45:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:45:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [12:45:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 10 u1: BPM st: NotStopd t0: [12:45:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:45:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [13:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 350 vu: ml t0: [13:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [12:45:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:45:00 14/05/2011] tf: [17:00:00 14/05/2011] dt: 255 id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:45:00 14/05/2011] 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: [13:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [13:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 164 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [13:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 119 u1: mmHg st: NotStopd t0: [13:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [13:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 11 u1: BPM st: NotStopd t0: [13:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [13:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [13:00:00 14/05/2011] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 14/05/2011] 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 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 97 u1: BPM st: NotStopd t0: [14:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [14:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [14:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [14:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 8 u1: BPM st: NotStopd t0: [14:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 14/05/2011] tf: [15:00:00 14/05/2011] dt: 60 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml st: Restart t0: [14:00:00 14/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [14:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [14:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 450 vu: ml t0: [14:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [14:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 250 su: ml rt: IV Drip t0: [14:00:00 14/05/2011] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 14/05/2011] 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 14/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Insp Wheeze st: NotStopd t0: [12:00:00 14/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 14/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [12:00:00 14/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 14/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [12:00:00 14/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 14/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [12:00:00 14/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [12:00:00 14/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 14/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [13:00:00 14/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [13:00:00 14/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [13:00:00 14/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [13:00:00 14/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 14/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [13:00:00 14/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 14/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [13:00:00 14/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [13:00:00 14/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 14/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [14:00:00 14/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 14/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 14/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 14/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 14/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 14/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 14/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 14/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 14/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd
t0: [14:30:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip
t0: [14:30:00 14/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [14:30:00 14/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [14:30:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 2.5 vu: ml t0: [14:30:00 14/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 40 vu: ml t0: [14:30:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2.5 vu: ml t0: [14:30:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [23:00:00 14/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 100 ap: none
t0: [15:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [15:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 172 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [15:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 122 u1: mmHg st: NotStopd t0: [15:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [15:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [15:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 14/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 14/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [16:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [16:00:00 14/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 14/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [16:00:00 14/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 14/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 14/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 14/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 14/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [16:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 14/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 14/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 14/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [16:00:00 14/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 14/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 14/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [16:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 14/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 14/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [16:00:00 14/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 14/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 14/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 183 u1: mmHg v2: 95 u2: mmHg st: NotStopd t0: [16:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 131 u1: mmHg st: NotStopd t0: [16:00:00 14/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [16:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [16:00:00 14/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 14/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [16:00:00 14/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [16:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 14/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 14/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 14/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 14/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [15:00:00 14/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml st: Stopped t0: [15:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 2.5 vu: ml t0: [15:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [15:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml t0: [16:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [16:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [16:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 510 vu: ml t0: [16:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [15:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [15:00:00 14/05/2011] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 14/05/2011] 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 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:00:00 14/05/2011] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 14/05/2011] 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 14/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 0 cv: 570 ap: none
t0: [16:00:00 14/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [16:00:00 14/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 14/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 14/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 14/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 14/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [16:00:00 14/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 14/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 14/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 14/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 14/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [16:00:00 14/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [16:00:00 14/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 14/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 14/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 14/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [16:00:00 14/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 14/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 14/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 14/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 14/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 14/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 14/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 14/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 14/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 14/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [16:00:00 14/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 14/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 14/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [16:00:00 14/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 14/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 14/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [16:00:00 14/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 14/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [16:00:00 14/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 14/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [16:00:00 14/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 14/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [16:00:00 14/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [16:00:00 14/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd
t0: [16:42:00 14/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [16:42:00 14/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:42:00 14/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14.5 t0: [16:42:00 14/05/2011] id: Extubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [16:42:00 14/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:42:00 14/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [16:42:00 14/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [16:42:00 14/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:42:00 14/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:42:00 14/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:42:00 14/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [16:42:00 14/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [16:42:00 14/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [16:42:00 14/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.5 u1: L/min st: NotStopd t0: [16:42:00 14/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:42:00 14/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:42:00 14/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [16:42:00 14/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [16:42:00 14/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [16:42:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [16:42:00 14/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [16:42:00 14/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [16:42:00 14/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 638 u1: ml/B st: NotStopd t0: [16:42:00 14/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:42:00 14/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [16:42:00 14/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:42:00 14/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [16:42:00 14/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:42:00 14/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [15:00:00 14/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.83 u1: L/min st: NotStopd t0: [15:00:00 14/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [15:00:00 14/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [15:00:00 14/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 756 u1: ml/B st: NotStopd
t0: [16:00:00 14/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 14/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [17:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 177 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [17:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 120 u1: mmHg st: NotStopd t0: [17:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [17:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [17:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [17:00:00 14/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [17:00:00 14/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [17:00:00 14/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [17:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:00:00 14/05/2011] 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: [17:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml
t0: [17:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [17:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [17:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [17:00:00 14/05/2011] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip st: Stopped
t0: [17:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [17:30:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:30:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [17:30:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:30:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:30:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:30:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:30:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:30:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [17:30:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:30:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 185 u1: mmHg v2: 98 u2: mmHg st: NotStopd t0: [17:30:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 134 u1: mmHg st: NotStopd t0: [17:30:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:30:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [17:30:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [17:30:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [17:30:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:30:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:30:00 14/05/2011] 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: [12:45:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN u1: mmHg st: NotStopd
tf: [17:00:00 15/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 18 dn: 1 m1: Metoprolol v1: 5 u1: mg
t0: [18:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [18:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 173 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [18:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 119 u1: mmHg st: NotStopd t0: [18:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [18:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [18:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 210 vu: ml
t0: [18:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [18:00:00 14/05/2011] 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 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:30:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [18:30:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:30:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 124 u1: BPM st: NotStopd t0: [18:30:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:30:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 191 u1: mmHg v2: 98 u2: mmHg st: NotStopd t0: [18:30:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 137 u1: mmHg st: NotStopd t0: [18:30:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:30:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [18:30:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [18:30:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:30:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:30:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [18:30:00 14/05/2011] 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: [17:20:00 14/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 106 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 133 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 u1: mEq/L rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 23 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 106 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 133 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 u1: mEq/L rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [17:20:00 14/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd
tf: [18:00:00 15/05/2011] pt: Unit Dose rt: IV fr: ONCE MR1 fs: 19 dn: 1 m1: Metoprolol v1: 5 u1: mg tf: [19:00:00 19/05/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Labetalol HCl v1: 200 u1: mg m2: D5W v2: 200 u2: ml
t0: [19:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [19:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 117 u1: BPM st: NotStopd t0: [19:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 192 u1: mmHg v2: 101 u2: mmHg st: NotStopd t0: [19:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 140 u1: mmHg st: NotStopd t0: [19:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [19:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [19:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [19:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 8 vu: ml t0: [19:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 290 vu: ml t0: [19:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [19:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [19:00:00 14/05/2011] 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 14/05/2011] id: Extubation Date el: 0 cu: MICU cg: -1 st: D/C'd
t0: [20:00:00 14/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 14/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [20:00:00 14/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 14/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 14/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 14/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 14/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 14/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 14/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [20:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 14/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 14/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 14/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [20:00:00 14/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 14/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 14/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 14/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 121 u1: BPM st: NotStopd t0: [20:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 14/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 14/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 14/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 14/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 14/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 14/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 14/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 14/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 14/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 14/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 172 u1: mmHg v2: 90 u2: mmHg st: NotStopd t0: [20:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 126 u1: mmHg st: NotStopd t0: [20:00:00 14/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [20:00:00 14/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 14/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 14/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 14/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 14/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [20:00:00 14/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 14/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 14/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 14/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 14/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 14/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 14/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 14/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [20:00:00 14/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 14/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 14/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [20:00:00 14/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 14/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 14/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [20:00:00 14/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 14/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [20:00:00 14/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [20:00:00 14/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 14/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 14/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [20:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [20:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [20:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 110 vu: ml t0: [20:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [20:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [20:00:00 14/05/2011] 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: [20:15:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:15:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [20:15:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:15:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:15:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:15:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:15:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:15:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 125 u1: BPM st: NotStopd t0: [20:15:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:15:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 160 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [20:15:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 119 u1: mmHg st: NotStopd t0: [20:15:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:15:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [20:15:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [20:15:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [20:15:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:15:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [20:15:00 14/05/2011] 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: [20:30:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:30:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:30:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:30:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:30:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:30:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:30:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 120 u1: BPM st: NotStopd t0: [20:30:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:30:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [20:30:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 119 u1: mmHg st: NotStopd t0: [20:30:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:30:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [20:30:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [20:30:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [20:30:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:30:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [20:30:00 14/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [20:30:00 14/05/2011] 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: [20:30:00 14/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml nb: 1
t0: [20:30:00 14/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [20:30:00 14/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:30:00 14/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14.5 t0: [20:30:00 14/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:30:00 14/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:30:00 14/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:30:00 14/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:30:00 14/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:30:00 14/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:30:00 14/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:30:00 14/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:30:00 14/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [20:30:00 14/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9 u1: L/min st: NotStopd t0: [20:30:00 14/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:30:00 14/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:30:00 14/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [20:30:00 14/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [20:30:00 14/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:30:00 14/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [20:30:00 14/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [20:30:00 14/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 700 u1: ml/B st: NotStopd t0: [20:30:00 14/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:30:00 14/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [20:30:00 14/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:30:00 14/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [20:30:00 14/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:30:00 14/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [21:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 14/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [21:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [21:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [21:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [21:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [21:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [21:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [21:00:00 14/05/2011] tf: [14:07:00 24/05/2011] dt: 13987 id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15 vu: ml t0: [21:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [21:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 160 vu: ml t0: [21:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [21:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [21:00:00 14/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [21:00:00 14/05/2011] 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 14/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 14/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 14/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [20:00:00 14/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 14/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 14/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 14/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 14/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 14/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 14/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 14/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [21:00:00 14/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 14/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 14/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 14/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 14/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 14/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [21:00:00 14/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd
t0: [21:45:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:45:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:45:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:45:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:45:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:45:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:45:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [21:45:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:45:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [21:45:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [21:45:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:45:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [21:45:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [21:45:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [21:45:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 14/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [22:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [22:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [22:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [22:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 14/05/2011] id: Previous Weight el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [22:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [22:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [22:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [22:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:45:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [21:45:00 14/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [21:45:00 14/05/2011] 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 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [22:00:00 14/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [22:00:00 14/05/2011] 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: [11:00:00 15/05/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 12.5 u1: mg
t0: [22:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd
t0: [22:00:00 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [22:00:00 14/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [22:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [22:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml t0: [22:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [23:00:00 14/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 14/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 14/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 14/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 14/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 14/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 14/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 113 u1: BPM st: NotStopd t0: [23:00:00 14/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 14/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [23:00:00 14/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 111 u1: mmHg st: NotStopd t0: [23:00:00 14/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 14/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [23:00:00 14/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [23:00:00 14/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [23:00:00 14/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [23:00:00 14/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [23:00:00 14/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [23:00:00 14/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 14/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [23:00:00 14/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [23:00:00 14/05/2011] 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 14/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [23:00:00 14/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [23:00:00 14/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [23:00:00 14/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [23:00:00 14/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [23:00:00 14/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 80 cv: 80 ap: none t0: [23:00:00 14/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 80 cv: 3780 ap: none t0: [23:00:00 14/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 80 cv: 3825 ap: carryForward
t0: [22:00:00 14/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [22:00:00 14/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 14/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 14/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [22:00:00 14/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [22:00:00 14/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [22:00:00 14/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 14/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 14/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 14/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 14/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 14/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 14/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 14/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd
t0: [00:00:00 15/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 15/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 15/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 15/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 15/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 15/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 15/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 15/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [00:00:00 15/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 15/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 15/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [00:00:00 15/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 15/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 15/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 15/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 15/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 15/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 15/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 15/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 15/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [00:00:00 15/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 15/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 15/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [00:00:00 15/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [00:00:00 15/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 15/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 15/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 15/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [00:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [00:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [00:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [00:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [23:00:00 14/05/2011] id: CVP el: 0 cu: MICU cg: RN u1: mmHg st: NotStopd t0: [00:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 111 u1: BPM st: NotStopd t0: [00:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [00:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [00:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [00:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [00:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [00:00:00 15/05/2011] 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: [21:45:00 14/05/2011] id: Significant Events el: 0 cu: MICU cg: RN st: NotStopd
t0: [00:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 15/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 15/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [00:00:00 15/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 15/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 15/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [00:00:00 15/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 15/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 15/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 15/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 15/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 15/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 15/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 15/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 15/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 15/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [00:00:00 15/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd
t0: [22:00:00 14/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [00:00:00 15/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 15/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 15/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [00:00:00 15/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 15/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 15/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 15/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 15/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 15/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 15/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd
t0: [23:00:00 14/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -39 cv: -39 ap: none t0: [23:00:00 14/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 41 cv: 768.625 ap: none t0: [23:00:00 14/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 41 cv: 1813.62 ap: none t0: [23:00:00 14/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -39 cv: -2011.38 ap: carryForward t0: [23:00:00 14/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -39 cv: 24292.5 ap: carryForward
t0: [01:02:00 15/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd t0: [01:02:00 15/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 15.3363 u1: ml/dl st: NotStopd t0: [01:02:00 15/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 97 rs: Final st: NotStopd t0: [01:02:00 15/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -3 rs: Final st: NotStopd t0: [01:02:00 15/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 24 rs: Final st: NotStopd t0: [01:02:00 15/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [01:02:00 15/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 118 u1: mmHg rs: Final st: NotStopd t0: [01:02:00 15/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd t0: [01:02:00 15/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 97 rs: Final st: NotStopd t0: [01:02:00 15/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.19 rs: Final st: NotStopd t0: [01:02:00 15/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 98 u1: % rs: Final st: NotStopd
t0: [01:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [01:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 101 u1: BPM st: NotStopd t0: [01:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [01:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 116 u1: mmHg st: NotStopd t0: [01:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [01:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [01:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [01:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [01:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [01:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [01:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [01:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [01:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [01:00:00 15/05/2011] 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 15/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 15/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 15/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 15/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 15/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [00:00:00 15/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [00:00:00 15/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 15/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd
t0: [00:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [01:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml
t0: [01:00:00 15/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [01:00:00 15/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [01:00:00 15/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14.5 t0: [01:00:00 15/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [01:00:00 15/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [01:00:00 15/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [01:00:00 15/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [01:00:00 15/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [01:00:00 15/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [01:00:00 15/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [01:00:00 15/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [01:00:00 15/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [01:00:00 15/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [01:00:00 15/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 15/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 15/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [01:00:00 15/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [01:00:00 15/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [01:00:00 15/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [01:00:00 15/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [01:00:00 15/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 625 u1: ml/B st: NotStopd t0: [01:00:00 15/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [01:00:00 15/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [01:00:00 15/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [01:00:00 15/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [01:00:00 15/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [01:00:00 15/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 15/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 15/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 15/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 15/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 15/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:00:00 15/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 15/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 15/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [02:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [02:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 15/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [02:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 15/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [02:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 111 u1: BPM st: NotStopd t0: [02:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 15/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [02:00:00 15/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [02:00:00 15/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [02:00:00 15/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [02:00:00 15/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [02:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 166 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [02:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 121 u1: mmHg st: NotStopd t0: [02:00:00 15/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [02:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 15/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [02:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [02:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [02:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [02:00:00 15/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [02:00:00 15/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [02:00:00 15/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [02:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [02:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [02:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [02:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [02:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [02:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [02:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [02:00:00 15/05/2011] 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 15/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 240 cv: 240 ap: none t0: [23:00:00 15/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -199 cv: -199 ap: none t0: [23:00:00 15/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 41 cv: 1484 ap: none t0: [23:00:00 15/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 41 cv: 1704 ap: none t0: [23:00:00 15/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 240 cv: 3195 ap: none t0: [23:00:00 15/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -199 cv: -1630 ap: carryForward t0: [23:00:00 15/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 240 cv: 3334 ap: carryForward t0: [23:00:00 15/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -199 cv: 22662.5 ap: carryForward
t0: [02:15:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:15:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:15:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:15:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:15:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:15:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:15:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [02:15:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:15:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [02:15:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [02:15:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:15:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [02:15:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 10 u1: BPM st: NotStopd t0: [02:15:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 92 u1: % st: NotStopd t0: [02:15:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:15:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [02:15:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip st: Stopped t0: [02:15:00 15/05/2011] 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 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [03:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [03:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [03:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [03:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [03:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 10 u1: BPM st: NotStopd t0: [03:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 92 u1: % st: NotStopd t0: [03:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 15/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 15/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 15/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 15/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 15/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 15/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 15/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [04:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 15/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 15/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 15/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [04:00:00 15/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 15/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 15/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [04:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 15/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 15/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 15/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [04:00:00 15/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 15/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [04:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [04:00:00 15/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 10 u1: BPM st: NotStopd t0: [04:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [04:00:00 15/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 15/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 15/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [03:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [03:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [03:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [03:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [04:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [04:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [04:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [04:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 110 vu: ml t0: [04:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [03:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [03:00:00 15/05/2011] 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 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [04:00:00 15/05/2011] 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: [03:30:00 15/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.8 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 7.8 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 32.7 u1: % rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 11.2 u1: gm/dl rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 206 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.78 u1: /mic l rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.8 rs: Final st: NotStopd
t0: [05:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [05:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [05:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [05:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [05:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 10 u1: BPM st: NotStopd t0: [05:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [05:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 15/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [05:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [05:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [05:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [05:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [05:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [05:00:00 15/05/2011] 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: [03:30:00 15/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.9 u1: mg/dl rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 80 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 u1: mEq/L rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.9 u1: mg/dl rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 25 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 80 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 u1: mEq/L rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 rs: Final st: NotStopd t0: [03:30:00 15/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [04:00:00 15/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 15/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 15/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 15/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 15/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 15/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 15/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 15/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 15/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 15/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 15/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [04:00:00 15/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [04:00:00 15/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 15/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd
t0: [04:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 15/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 15/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 15/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [04:00:00 15/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 15/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [04:00:00 15/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 15/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 15/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd
t0: [06:00:00 15/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [06:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [06:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [06:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [06:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 150 vu: ml t0: [06:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [00:00:00 15/05/2011] tf: [08:00:00 15/05/2011] dt: 480 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml nb: 1 t0: [00:00:00 15/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [01:00:00 15/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [02:00:00 15/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [03:00:00 15/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [04:00:00 15/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [05:00:00 15/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [06:00:00 15/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml
t0: [06:00:00 15/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [06:00:00 15/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [06:00:00 15/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [06:00:00 15/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [06:00:00 15/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [06:00:00 15/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [06:00:00 15/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [06:00:00 15/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd
t0: [06:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [06:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 15/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [06:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [06:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 15/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [06:00:00 15/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [06:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [06:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [06:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [06:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [06:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 92 u1: % st: NotStopd t0: [06:00:00 15/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [06:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 15/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 14 vu: ml
t0: [06:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [06:00:00 15/05/2011] 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: [05:00:00 15/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 32 u1: units st: NotStopd t0: [05:00:00 15/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14.5 t0: [05:00:00 15/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [05:00:00 15/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [05:00:00 15/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [05:00:00 15/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [05:00:00 15/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:00:00 15/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [05:00:00 15/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [05:00:00 15/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [05:00:00 15/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [05:00:00 15/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [05:00:00 15/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 15/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 15/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [05:00:00 15/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 32 u1: units st: NotStopd t0: [05:00:00 15/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [05:00:00 15/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [05:00:00 15/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [05:00:00 15/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.5 u1: L st: NotStopd t0: [05:00:00 15/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [05:00:00 15/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [05:00:00 15/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 563 u1: ml/B st: NotStopd t0: [05:00:00 15/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [05:00:00 15/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [06:00:00 15/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [06:00:00 15/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 15/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [06:00:00 15/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 15/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [06:00:00 15/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 15/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 15/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [06:00:00 15/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [06:00:00 15/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [07:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [07:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [07:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [07:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [07:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [07:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 92 u1: % st: NotStopd t0: [07:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 15/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [07:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [07:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [07:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [07:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [07:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [07:00:00 15/05/2011] 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 15/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [06:00:00 15/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [06:00:00 15/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd
t0: [22:00:00 14/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd t0: [06:00:00 15/05/2011] id: Significant Events el: 0 cu: MICU cg: RN st: NotStopd
tf: [06:00:00 16/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 7 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm tf: [06:00:00 16/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 7 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq
t0: [07:00:00 15/05/2011] tf: [00:00:00 16/05/2011] dt: 1020 id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [07:03:00 15/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.17 rs: Final st: NotStopd
t0: [08:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 15/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 15/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [08:00:00 15/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [08:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 15/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 15/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 15/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 15/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 15/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 15/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 15/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 15/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 15/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 15/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [08:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 15/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 15/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [08:00:00 15/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 15/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [08:00:00 15/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 15/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 15/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 15/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 115 u1: BPM st: NotStopd t0: [08:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 15/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 15/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [08:00:00 15/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 15/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 15/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 15/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 15/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 15/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 15/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 15/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [08:00:00 15/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [08:00:00 15/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 15/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [08:00:00 15/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 15/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 15/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 15/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 15/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [08:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [08:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 15/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [08:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [08:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 15/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [08:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 15/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 15/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 15/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [08:00:00 15/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [08:00:00 15/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 15/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 15/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 15/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [08:00:00 15/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [08:00:00 15/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [08:00:00 15/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [08:00:00 15/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [08:00:00 15/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Pink v2: Sediment st: NotStopd t0: [08:00:00 15/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 15/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [08:00:00 15/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 15/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 15/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 15/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 15/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 15/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 15/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 15/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 15/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [08:00:00 15/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 15/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 15/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [08:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [08:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [08:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [08:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 390 vu: ml t0: [08:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [08:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [08:00:00 15/05/2011] 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 15/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [08:00:00 15/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml t0: [08:00:00 15/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml st: Stopped t0: [08:00:00 15/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 40 vu: ml
t0: [23:00:00 15/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 40 ap: none t0: [23:00:00 15/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 180 ap: none
t0: [08:00:00 15/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 15/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14.5 t0: [08:00:00 15/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 15/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [08:00:00 15/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [08:00:00 15/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 15/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [08:00:00 15/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [08:00:00 15/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [08:00:00 15/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7 u1: L/min st: NotStopd t0: [08:00:00 15/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 15/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 15/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [08:00:00 15/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [08:00:00 15/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:00:00 15/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 560 u1: ml/B st: NotStopd t0: [08:00:00 15/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 15/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd
t0: [08:00:00 15/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 4 u1: mmHg st: NotStopd t0: [09:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [09:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [09:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [09:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [09:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [09:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [09:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [09:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [09:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [09:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 255 vu: ml t0: [09:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [09:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [09:00:00 15/05/2011] 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 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [10:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 174 u1: mmHg v2: 98 u2: mmHg st: NotStopd t0: [10:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 132 u1: mmHg st: NotStopd t0: [10:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [10:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [10:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [10:00:00 15/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [10:00:00 15/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [10:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [10:00:00 15/05/2011] 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: [09:00:00 15/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [09:00:00 15/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 15/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [09:00:00 15/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 15/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 15/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 15/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 15/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [09:00:00 15/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 15/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 15/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [09:00:00 15/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [09:00:00 15/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [10:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 15/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [10:00:00 15/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [10:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 15/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [10:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd
t0: [10:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [10:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [10:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [10:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 105 vu: ml t0: [10:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [08:00:00 15/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 15/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 15/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 15/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 15/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [08:00:00 15/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 15/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 15/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 15/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd
t0: [11:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [11:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [11:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [11:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [11:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [11:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [11:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [11:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [11:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [11:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 140 vu: ml t0: [11:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [11:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [11:00:00 15/05/2011] 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 15/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 127 rs: Manual st: NotStopd
t0: [12:00:00 15/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [12:00:00 15/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:00:00 15/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14.5 t0: [12:00:00 15/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 15/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [12:00:00 15/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [12:00:00 15/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 15/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 15/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [12:00:00 15/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [12:00:00 15/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [12:00:00 15/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [12:00:00 15/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.1 u1: L/min st: NotStopd t0: [12:00:00 15/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 15/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 15/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [12:00:00 15/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 23 u1: BPM st: NotStopd t0: [12:00:00 15/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [12:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [12:00:00 15/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 530 u1: ml/B st: NotStopd t0: [12:00:00 15/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:00:00 15/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [12:00:00 15/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:00:00 15/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [12:00:00 15/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:00:00 15/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [12:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [12:00:00 15/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 15/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [12:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 15/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 15/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 15/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 15/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 15/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: Occasional st: NotStopd t0: [12:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: PVC's st: NotStopd t0: [12:00:00 15/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 15/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 15/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 15/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 15/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [12:00:00 15/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 15/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 15/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 15/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 15/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [12:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 15/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [12:00:00 15/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [12:00:00 15/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 15/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 15/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 15/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [12:00:00 15/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 15/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 15/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 15/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [12:00:00 15/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [12:00:00 15/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 15/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 15/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 15/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [12:00:00 15/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [12:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [12:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [12:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 15/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [12:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 15/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [12:00:00 15/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 15/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 15/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 15/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 15/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3889 u1: Deg. C st: NotStopd t0: [12:00:00 15/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.5 u1: Deg. F st: NotStopd t0: [12:00:00 15/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [12:00:00 15/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 15/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 15/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 15/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 15/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [12:00:00 15/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [12:00:00 15/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 15/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 15/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [12:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [12:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [12:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [12:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [12:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [12:00:00 15/05/2011] 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: [13:00:00 15/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [13:00:00 15/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Trach Mask st: NotStopd t0: [13:00:00 15/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT v1: 12 u1: lpm st: NotStopd t0: [13:00:00 15/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [13:00:00 15/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd
t0: [13:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [13:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [13:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [13:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [13:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [13:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [13:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 110 u1: BPM st: NotStopd t0: [14:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [14:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [14:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [14:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [14:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [14:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 15/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [14:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [14:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 8 vu: ml t0: [14:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 565 vu: ml t0: [14:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [13:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [13:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [13:00:00 15/05/2011] 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 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [14:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [14:00:00 15/05/2011] 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: [14:16:00 15/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.28 rs: Final st: NotStopd t0: [14:16:00 15/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -1 rs: Final st: NotStopd t0: [14:16:00 15/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 27 rs: Final st: NotStopd t0: [14:16:00 15/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 56 u1: mmHg rs: Final st: NotStopd t0: [14:16:00 15/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 113 u1: mmHg rs: Final st: NotStopd t0: [14:16:00 15/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.28 rs: Final st: NotStopd
t0: [14:28:00 15/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [14:28:00 15/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd
t0: [12:00:00 15/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 15/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 15/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 15/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd
t0: [15:00:00 15/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: -1 st: D/C'd t0: [15:00:00 15/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: -1 st: D/C'd t0: [15:00:00 15/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: -1 st: D/C'd
t0: [12:00:00 15/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [12:00:00 15/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [14:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [14:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 15/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [14:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 15/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 15/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [14:00:00 15/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 15/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 15/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 15/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 15/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [14:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 15/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 15/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 15/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [14:00:00 15/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 15/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [15:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [15:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [15:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [15:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [15:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [15:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [15:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [15:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [15:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [15:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [15:00:00 15/05/2011] 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 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [16:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [16:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [16:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [16:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [16:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [16:00:00 15/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 15/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [16:00:00 15/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [16:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [16:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [16:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [16:00:00 15/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 25 vu: ml t0: [16:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 180 vu: ml t0: [16:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [16:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [16:00:00 15/05/2011] 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 15/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 39 ap: none
t0: [12:00:00 15/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [12:00:00 15/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [16:00:00 15/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 15/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [16:00:00 15/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 15/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 15/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 15/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 15/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 15/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 15/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 15/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 15/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 15/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 15/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [16:00:00 15/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 15/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 15/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 15/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 15/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [16:00:00 15/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [16:00:00 15/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 15/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [16:00:00 15/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 15/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [16:00:00 15/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 15/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 15/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 15/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 15/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [16:00:00 15/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [16:00:00 15/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 15/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [16:00:00 15/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 15/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 15/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 15/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [16:00:00 15/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 15/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [16:00:00 15/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [16:00:00 15/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 15/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 15/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [16:00:00 15/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 15/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 15/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [16:00:00 15/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [16:00:00 15/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [16:00:00 15/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 15/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 15/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [16:00:00 15/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 15/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 15/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 15/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 15/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 15/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 15/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 15/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 15/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 15/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [16:00:00 15/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 15/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [16:00:00 15/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [16:00:00 15/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 15/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 15/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [15:57:00 15/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd t0: [15:57:00 15/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: -1 rs: Final st: NotStopd t0: [15:57:00 15/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 26 rs: Final st: NotStopd t0: [15:57:00 15/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 48 u1: mmHg rs: Final st: NotStopd t0: [15:57:00 15/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 112 u1: mmHg rs: Final st: NotStopd t0: [15:57:00 15/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd
t0: [16:00:00 15/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [16:00:00 15/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:00:00 15/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14.5 t0: [16:00:00 15/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 15/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [16:00:00 15/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [16:00:00 15/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 15/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 15/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:00:00 15/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [16:00:00 15/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [16:00:00 15/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [16:00:00 15/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.9 u1: L/min st: NotStopd t0: [16:00:00 15/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 15/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 15/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [16:00:00 15/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [16:00:00 15/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [16:00:00 15/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 530 u1: ml/B st: NotStopd t0: [16:00:00 15/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:00:00 15/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [16:00:00 15/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:00:00 15/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [16:00:00 15/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:00:00 15/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [17:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 101 u1: BPM st: NotStopd t0: [17:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [17:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [17:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [17:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [17:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [17:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [17:00:00 15/05/2011] 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: [17:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [17:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [17:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [17:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [18:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [18:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [18:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [18:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [18:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [18:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [18:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [18:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [18:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [18:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [18:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [18:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 15/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 132 rs: Manual st: NotStopd
t0: [18:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [18:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [18:00:00 15/05/2011] 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 15/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [18:00:00 15/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [18:00:00 15/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 15/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 15/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 15/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 15/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [18:00:00 15/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 15/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 15/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [18:00:00 15/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 15/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [18:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 360 vu: ml
t0: [20:00:00 15/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: 2827 v1: 3 v2: 26 st: NotStopd t0: [20:00:00 15/05/2011] id: Cuff Leak el: 0 cu: MICU cg: 2827 v1: No st: NotStopd t0: [20:00:00 15/05/2011] id: high exhale MV el: 0 cu: MICU cg: 2827 v1: 15 t0: [20:00:00 15/05/2011] id: FiO2 Set el: 0 cu: MICU cg: 2827 v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 15/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: 2827 v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 15/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: 2827 v1: 35 u1: BPM st: NotStopd t0: [20:00:00 15/05/2011] id: Airway Type el: 0 cu: MICU cg: 2827 v1: Tracheostomy st: NotStopd t0: [20:00:00 15/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: 2827 v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 15/05/2011] id: Intubation Date el: 0 cu: MICU cg: 2827 v1: 3 v2: 12 st: NotStopd t0: [20:00:00 15/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: 2827 v1: 4 st: NotStopd t0: [20:00:00 15/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: 2827 v1: 6 v2: Combivent st: NotStopd t0: [20:00:00 15/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: 2827 v1: 7 u1: cmH2O st: NotStopd t0: [20:00:00 15/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: 2827 v1: 10.9 u1: L/min st: NotStopd t0: [20:00:00 15/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: 2827 v1: Trach Mask st: NotStopd t0: [20:00:00 15/05/2011] id: PEEP Set el: 0 cu: MICU cg: 2827 v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 15/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: 2827 v1: 20 st: NotStopd t0: [20:00:00 15/05/2011] id: Pressure Support el: 0 cu: MICU cg: 2827 v1: 8 u1: . st: NotStopd t0: [20:00:00 15/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: 2827 v1: 25 u1: BPM st: NotStopd t0: [20:00:00 15/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: 2827 v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 15/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: 2827 v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 15/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: 2827 v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 15/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: 2827 v1: 510 u1: ml/B st: NotStopd t0: [20:00:00 15/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: 2827 v1: Yes v2: No st: NotStopd t0: [20:00:00 15/05/2011] id: Trach Size el: 0 cu: MICU cg: 2827 v1: #6 st: NotStopd t0: [20:00:00 15/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: 2827 v1: Inflated st: NotStopd t0: [20:00:00 15/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: 2827 v1: Shiley st: NotStopd t0: [20:00:00 15/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: 2827 v1: CPAP+PS st: NotStopd t0: [20:00:00 15/05/2011] id: Ventilator Type el: 0 cu: MICU cg: 2827 v1: Drager st: NotStopd
t0: [19:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [19:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 159 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [19:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [19:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [19:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [19:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 15/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 15/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 15/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 15/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 15/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 15/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 15/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 15/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [20:00:00 15/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 15/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 15/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 15/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [20:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 15/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 15/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 15/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [20:00:00 15/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 15/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 15/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 15/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 15/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 15/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 15/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 15/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 15/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 15/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 15/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [20:00:00 15/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 15/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 15/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 15/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 15/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [20:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [20:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 15/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [20:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [20:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 15/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [20:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 15/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 15/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 15/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [20:00:00 15/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [20:00:00 15/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 15/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 15/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 15/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [20:00:00 15/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 15/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 15/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 15/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 15/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 15/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 15/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 15/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 15/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 15/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [20:00:00 15/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 15/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [20:00:00 15/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [20:00:00 15/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 15/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 15/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [19:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [19:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [19:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [19:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [20:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [20:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [20:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [20:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 240 vu: ml t0: [20:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [19:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [19:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [19:00:00 15/05/2011] 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 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [20:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [20:00:00 15/05/2011] 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 15/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 15/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [20:00:00 15/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd
t0: [21:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 103 u1: BPM st: NotStopd t0: [21:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 163 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [21:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 119 u1: mmHg st: NotStopd t0: [21:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [21:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [21:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [21:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [21:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [21:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [21:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 180 vu: ml t0: [21:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [21:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [21:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [21:00:00 15/05/2011] 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 15/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 15/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 15/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 15/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd
t0: [22:00:00 15/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [22:00:00 15/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [22:00:00 15/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 15/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [22:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 15/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 15/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 15/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [22:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [22:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 163 u1: mmHg v2: 89 u2: mmHg st: NotStopd t0: [22:00:00 15/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [22:00:00 15/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 122 u1: mmHg st: NotStopd t0: [22:00:00 15/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [22:00:00 15/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 15/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [22:00:00 15/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 15/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 15/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 15/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 15/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [22:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [22:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [22:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [22:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [22:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [22:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [22:00:00 15/05/2011] 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 15/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 15/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 15/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 15/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 15/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [20:00:00 15/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 15/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 15/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [20:00:00 15/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 15/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [20:00:00 15/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Medium
t0: [23:00:00 15/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [20:00:00 15/05/2011] tf: [14:07:00 24/05/2011] dt: 12607 id: Drain Out #1 Other el: 1 cu: MICU cg: RN vo: 100 vu: ml
t0: [23:00:00 15/05/2011] dt: 24 id: Drain #1 Total Out el: 2 cu: MICU cg: RN cv: 100 ap: none
tf: [23:00:00 16/05/2011] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 25 u1: mg
t0: [23:00:00 15/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 15/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 15/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 15/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 15/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 15/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 15/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [23:00:00 15/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 15/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [23:00:00 15/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [23:00:00 15/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 15/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [23:00:00 15/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [23:00:00 15/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 15/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [23:00:00 15/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [23:00:00 15/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [23:00:00 15/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 240 vu: ml t0: [23:00:00 15/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [23:00:00 15/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [23:00:00 15/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [23:00:00 15/05/2011] 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 15/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: 2827 u1: lpm st: NotStopd t0: [00:00:00 16/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: 2827 v1: 3 v2: 26 st: NotStopd t0: [00:00:00 16/05/2011] id: Cuff Leak el: 0 cu: MICU cg: 2827 v1: No st: NotStopd t0: [00:00:00 16/05/2011] id: high exhale MV el: 0 cu: MICU cg: 2827 v1: 12 t0: [00:00:00 16/05/2011] id: FiO2 Set el: 0 cu: MICU cg: 2827 v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 16/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: 2827 v1: 30 u1: cmH2O st: NotStopd t0: [00:00:00 16/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: 2827 v1: 30 u1: BPM st: NotStopd t0: [00:00:00 16/05/2011] id: Airway Type el: 0 cu: MICU cg: 2827 v1: Tracheostomy st: NotStopd t0: [00:00:00 16/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: 2827 v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 16/05/2011] id: Intubation Date el: 0 cu: MICU cg: 2827 v1: 3 v2: 12 st: NotStopd t0: [00:00:00 16/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: 2827 v1: 3.5 st: NotStopd t0: [00:00:00 16/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: 2827 v1: 6 v2: Combivent st: NotStopd t0: [00:00:00 16/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: 2827 v1: 6 u1: cmH2O st: NotStopd t0: [00:00:00 16/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: 2827 v1: 5.75 u1: L/min st: NotStopd t0: [00:00:00 16/05/2011] id: PEEP Set el: 0 cu: MICU cg: 2827 v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 16/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: 2827 v1: 20 st: NotStopd t0: [00:00:00 16/05/2011] id: Pressure Support el: 0 cu: MICU cg: 2827 v1: 8 u1: . st: NotStopd t0: [00:00:00 16/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: 2827 v1: 10 u1: BPM st: NotStopd t0: [00:00:00 16/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: 2827 v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: 2827 v1: 98 u1: % st: NotStopd t0: [00:00:00 16/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: 2827 v1: 575 u1: ml/B st: NotStopd t0: [00:00:00 16/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: 2827 v1: Yes v2: No st: NotStopd t0: [00:00:00 16/05/2011] id: Trach Size el: 0 cu: MICU cg: 2827 v1: #6 st: NotStopd t0: [00:00:00 16/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: 2827 v1: Inflated st: NotStopd t0: [00:00:00 16/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: 2827 v1: Shiley st: NotStopd t0: [00:00:00 16/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: 2827 v1: CPAP+PS st: NotStopd t0: [00:00:00 16/05/2011] id: Ventilator Type el: 0 cu: MICU cg: 2827 v1: Drager st: NotStopd
t0: [00:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [00:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [00:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [00:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 16/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [00:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [00:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 97 u1: BPM st: NotStopd t0: [01:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [01:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 109 u1: mmHg st: NotStopd t0: [01:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 16/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [01:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [01:00:00 16/05/2011] id: Significant Events el: 0 cu: MICU cg: RN st: NotStopd t0: [01:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [00:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [00:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [00:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [01:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [01:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [01:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [01:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 240 vu: ml t0: [01:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [00:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [01:00:00 16/05/2011] tf: [14:07:00 24/05/2011] dt: 12307 id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip st: Stopped t0: [00:00:00 16/05/2011] 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 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [01:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [01:00:00 16/05/2011] 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 16/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 220 cv: 220 ap: none t0: [23:00:00 16/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 220 cv: 2760 ap: none t0: [23:00:00 16/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 220 cv: 2848 ap: none
t0: [00:00:00 16/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 16/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 16/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 16/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 16/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 16/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 16/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 16/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 16/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 16/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 16/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 16/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 16/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 16/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 16/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 16/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 16/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [00:00:00 16/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [00:00:00 16/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 16/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 16/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 16/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 16/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 16/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 16/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [00:00:00 16/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 16/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 16/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 16/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 16/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 16/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 16/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 16/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 16/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 16/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 16/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [00:00:00 16/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 16/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 16/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 16/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 16/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 16/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 16/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [00:00:00 16/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 16/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 16/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 16/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 16/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 16/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 16/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 16/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 16/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 16/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [00:00:00 16/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 16/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [00:00:00 16/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serous st: NotStopd t0: [00:00:00 16/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 16/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 16/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [23:00:00 15/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [23:00:00 15/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [23:00:00 15/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [23:00:00 15/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [23:00:00 15/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [23:00:00 15/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [23:00:00 15/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [23:00:00 15/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 16/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 16/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 16/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [00:00:00 16/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 16/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 16/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 16/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 16/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 16/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 16/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd
t0: [01:00:00 16/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [01:00:00 16/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [01:00:00 16/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [02:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [02:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [02:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [02:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 16/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [02:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 10 u1: BPM st: NotStopd t0: [02:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [02:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [02:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [02:00:00 16/05/2011] 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 16/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [02:00:00 16/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [02:00:00 16/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 16/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [02:00:00 16/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 16/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 16/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [02:00:00 16/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [02:00:00 16/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Arm, Left Lower st: NotStopd t0: [02:00:00 16/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [02:00:00 16/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [02:00:00 16/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 16/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 16/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 16/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 16/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 16/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 16/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 16/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 16/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd
t0: [02:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [02:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [02:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [02:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [22:00:00 15/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [00:00:00 16/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [23:00:00 16/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -172 cv: -172 ap: none t0: [23:00:00 16/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 38 cv: 1556 ap: none t0: [23:00:00 16/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 48 cv: 1836 ap: none t0: [23:00:00 16/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -172 cv: -1012 ap: none t0: [23:00:00 16/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -172 cv: 21650.5 ap: carryForward
t0: [03:51:00 16/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd t0: [03:51:00 16/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [03:51:00 16/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [03:51:00 16/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 48 u1: mmHg rs: Final st: NotStopd t0: [03:51:00 16/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 107 u1: mmHg rs: Final st: NotStopd t0: [03:51:00 16/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd
t0: [03:51:00 16/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.22 rs: Final st: NotStopd t0: [03:51:00 16/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 98 u1: % rs: Final st: NotStopd
t0: [04:00:00 16/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: 2827 v1: 20 u1: units st: NotStopd t0: [04:00:00 16/05/2011] id: high exhale MV el: 0 cu: MICU cg: 2827 v1: 12 t0: [04:00:00 16/05/2011] id: FiO2 Set el: 0 cu: MICU cg: 2827 v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 16/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: 2827 v1: 30 u1: cmH2O st: NotStopd t0: [04:00:00 16/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: 2827 v1: 30 u1: BPM st: NotStopd t0: [04:00:00 16/05/2011] id: Airway Type el: 0 cu: MICU cg: 2827 v1: Tracheostomy st: NotStopd t0: [04:00:00 16/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: 2827 v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 16/05/2011] id: Intubation Date el: 0 cu: MICU cg: 2827 v1: 3 v2: 12 st: NotStopd t0: [04:00:00 16/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: 2827 v1: 4 st: NotStopd t0: [04:00:00 16/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: 2827 v1: 6 v2: Combivent st: NotStopd t0: [04:00:00 16/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: 2827 v1: 6 u1: cmH2O st: NotStopd t0: [04:00:00 16/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: 2827 v1: 5.1 u1: L/min st: NotStopd t0: [04:00:00 16/05/2011] id: PEEP Set el: 0 cu: MICU cg: 2827 v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 16/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: 2827 v1: 20 st: NotStopd t0: [04:00:00 16/05/2011] id: Pressure Support el: 0 cu: MICU cg: 2827 v1: 8 u1: . st: NotStopd t0: [04:00:00 16/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: 2827 v1: 20 u1: units st: NotStopd t0: [04:00:00 16/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: 2827 v1: 9 u1: BPM st: NotStopd t0: [04:00:00 16/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: 2827 v1: 2 u1: cmH2O st: NotStopd t0: [04:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: 2827 v1: 98 u1: % st: NotStopd t0: [04:00:00 16/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: 2827 v1: 10 u1: BPM st: NotStopd t0: [04:00:00 16/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: 2827 v1: 0.5 u1: L st: NotStopd t0: [04:00:00 16/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: 2827 v1: 615 u1: ml/B st: NotStopd t0: [04:00:00 16/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: 2827 v1: CPAP+PS st: NotStopd t0: [04:00:00 16/05/2011] id: Ventilator Type el: 0 cu: MICU cg: 2827 v1: Drager st: NotStopd
t0: [03:45:00 16/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.1 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 7.1 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 31.9 u1: % rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.8 u1: gm/dl rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 191 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.6 u1: /mic l rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.1 rs: Final st: NotStopd t0: [03:51:00 16/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 14.5143 u1: ml/dl st: NotStopd
t0: [03:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [03:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [03:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [03:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 16/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [03:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 10 u1: BPM st: NotStopd t0: [03:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [03:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [04:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [04:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [04:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 16/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [04:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 10 u1: BPM st: NotStopd t0: [04:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [03:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [03:00:00 16/05/2011] 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 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [04:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [04:00:00 16/05/2011] 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 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [03:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [03:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [03:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [04:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [04:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [04:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [04:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 320 vu: ml t0: [04:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml t0: [05:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [05:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [05:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [05:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [04:00:00 16/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 16/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 16/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 16/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 16/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 16/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 16/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 16/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 16/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 16/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [04:00:00 16/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 16/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [04:00:00 16/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 16/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [04:00:00 16/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [04:00:00 16/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 16/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 16/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 16/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 16/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [04:00:00 16/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 16/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 16/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 16/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [04:00:00 16/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 16/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 16/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 16/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 16/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 16/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 16/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 16/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 16/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 16/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 16/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 16/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 16/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 16/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 16/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [04:00:00 16/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 16/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [04:00:00 16/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [02:00:00 16/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [02:00:00 16/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [02:00:00 16/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [02:00:00 16/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [02:00:00 16/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [02:00:00 16/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [02:00:00 16/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [02:00:00 16/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 16/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 16/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 16/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [04:00:00 16/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 16/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 16/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 16/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 16/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 16/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 16/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [05:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 16/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [05:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [05:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [05:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 16/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [05:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 9 u1: BPM st: NotStopd t0: [05:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [05:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [05:00:00 16/05/2011] 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: [03:45:00 16/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8 u1: mg/dl rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 73 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 u1: mEq/L rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8 u1: mg/dl rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 27 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 73 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 u1: mEq/L rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [03:45:00 16/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd
t0: [00:00:00 16/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 89 rs: Manual st: NotStopd
t0: [06:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [06:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [06:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [06:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 16/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [06:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 11 u1: BPM st: NotStopd t0: [06:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [06:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [06:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [06:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [06:00:00 16/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [06:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 150 vu: ml t0: [06:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [06:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [06:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [06:00:00 16/05/2011] 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 16/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 60 ap: none
t0: [07:00:00 16/05/2011] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: -1 st: D/C'd t0: [07:00:00 16/05/2011] id: ImpSkin Character #1 el: 0 cu: MICU cg: -1 st: D/C'd t0: [07:00:00 16/05/2011] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: -1 st: D/C'd t0: [07:00:00 16/05/2011] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: -1 st: D/C'd t0: [07:00:00 16/05/2011] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: -1 st: D/C'd t0: [07:00:00 16/05/2011] id: ImpSkin Wth/Lth #1 el: 0 cu: MICU cg: -1 st: D/C'd t0: [07:00:00 16/05/2011] id: Impaired Skin Site#1 el: 0 cu: MICU cg: -1 st: D/C'd
t0: [07:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [07:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [07:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 117 u1: mmHg st: NotStopd t0: [07:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 16/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [07:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [07:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [07:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [07:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [07:00:00 16/05/2011] 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 16/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 16/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [08:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 16/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 16/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 16/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 16/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 16/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 16/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 16/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 16/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 16/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 16/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 16/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 16/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 16/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 16/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 16/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [08:00:00 16/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 16/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 16/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [08:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 16/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 16/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 16/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [08:00:00 16/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Insp Wheeze st: NotStopd t0: [08:00:00 16/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 16/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 16/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 16/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [08:00:00 16/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [08:00:00 16/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [08:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 16/05/2011] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 77.8 u1: kg st: NotStopd t0: [08:00:00 16/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [08:00:00 16/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Insp Wheeze st: NotStopd t0: [08:00:00 16/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 16/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [08:00:00 16/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 16/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 16/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 16/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 16/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 16/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [08:00:00 16/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [08:00:00 16/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [08:00:00 16/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 16/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 16/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 16/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3889 u1: Deg. C st: NotStopd t0: [08:00:00 16/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.5 u1: Deg. F st: NotStopd t0: [08:00:00 16/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:00:00 16/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 16/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 16/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 16/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 16/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 16/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 16/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 16/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 16/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 16/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 16/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 16/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd
t0: [08:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 75 vu: ml t0: [08:00:00 16/05/2011] id: Drain Out #1 Other el: 1 cu: MICU cg: RN vo: 28 vu: ml t0: [08:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 8 vu: ml t0: [08:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 185 vu: ml t0: [08:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [08:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [08:00:00 16/05/2011] 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 16/05/2011] dt: 24 id: Drain #1 Total Out el: 2 cu: MICU cg: RN cv: 28 ap: none
t0: [08:00:00 16/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 16/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 16/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 16/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 16/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 16/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 16/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 16/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [08:00:00 16/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 16/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 16/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 16/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 16/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 16/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 16/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 16/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 16/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 16/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 16/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 16/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 16/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 16/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 16/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 16/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 16/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 16/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 16/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [08:00:00 16/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 16/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 16/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 16/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 16/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 16/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd
t0: [08:00:00 16/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [08:00:00 16/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 16/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 12 t0: [08:00:00 16/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 16/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [08:00:00 16/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 16/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 16/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 16/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:00:00 16/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [08:00:00 16/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [08:00:00 16/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [08:00:00 16/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.9 u1: L/min st: NotStopd t0: [08:00:00 16/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 16/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 16/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [08:00:00 16/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 12 u1: BPM st: NotStopd t0: [08:00:00 16/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:00:00 16/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 540 u1: ml/B st: NotStopd t0: [08:00:00 16/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 16/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [08:00:00 16/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 16/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [08:00:00 16/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [08:00:00 16/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 16/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [08:00:00 16/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [08:00:00 16/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [09:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [09:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [09:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [09:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [09:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [09:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [09:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [09:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [09:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [09:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [09:00:00 16/05/2011] 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: [09:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 250 vu: ml
t0: [10:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [10:00:00 16/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [10:00:00 16/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [10:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [10:00:00 16/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [10:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [10:00:00 16/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 16/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 65 vu: ml
t0: [10:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 40 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [10:00:00 16/05/2011] 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 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd
t0: [10:00:00 16/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [10:00:00 16/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 16/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 16/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 16/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 16/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 16/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 16/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 16/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 16/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [11:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [11:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [11:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [11:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [11:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 90 vu: ml t0: [11:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 8 vu: ml t0: [11:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 4 vu: ml
t0: [11:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 30 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [11:00:00 16/05/2011] 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: [11:00:00 16/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [11:00:00 16/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Trach Mask st: NotStopd t0: [11:00:00 16/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT v1: 12 u1: lpm st: NotStopd
t0: [11:00:00 16/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Bloody v2: Thick st: NotStopd t0: [11:00:00 16/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [12:00:00 16/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [12:00:00 16/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd
t0: [11:00:00 16/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [11:00:00 16/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [11:00:00 16/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [11:00:00 16/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [11:00:00 16/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 16/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [11:00:00 16/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [11:00:00 16/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [11:00:00 16/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [11:00:00 16/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 16/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [11:00:00 16/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [11:00:00 16/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [12:00:00 16/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [12:00:00 16/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 16/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 16/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [12:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 16/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 16/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 16/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 16/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 16/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 16/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 16/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 16/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 16/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 16/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 16/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 16/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 16/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 16/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [12:00:00 16/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 16/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 16/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [12:00:00 16/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 16/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 16/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [12:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 16/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 16/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 16/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 16/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 16/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 16/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 16/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 16/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [12:00:00 16/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [12:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [12:00:00 16/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 16/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [12:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 16/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [12:00:00 16/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Insp Wheeze st: NotStopd t0: [12:00:00 16/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 16/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 16/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [12:00:00 16/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 16/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 16/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 16/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 16/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [12:00:00 16/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 16/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 16/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [12:00:00 16/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [12:00:00 16/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 16/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 16/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 16/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [12:00:00 16/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [12:00:00 16/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [12:00:00 16/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 16/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 16/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 16/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 102 rs: Manual st: NotStopd t0: [12:00:00 16/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 16/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [12:00:00 16/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [12:00:00 16/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [12:00:00 16/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [12:00:00 16/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [12:00:00 16/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [12:00:00 16/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [12:00:00 16/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [12:00:00 16/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 16/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 16/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd
t0: [12:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 30 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [12:00:00 16/05/2011] 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
tf: [11:00:00 17/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 12 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm tf: [11:00:00 17/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 12 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq
t0: [11:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [12:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [12:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [12:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 3 vu: ml t0: [12:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 190 vu: ml t0: [12:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
tf: [19:00:00 19/05/2011] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Fentanyl Citrate v1: 2500 u1: mcg m2: D5W v2: 250 u2: ml tf: [19:00:00 19/05/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Midazolam HCl v1: 50 u1: mg m2: D5W v2: 50 u2: ml
t0: [13:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [13:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [13:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [13:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [13:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [13:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 150 vu: ml
t0: [13:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 30 du: mcghr sv: 250 su: ml rt: IV Drip t0: [13:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [13:00:00 16/05/2011] 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 16/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [14:00:00 16/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Expectorated v2: Copious st: NotStopd
t0: [15:28:00 16/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.28 rs: Final st: NotStopd t0: [15:28:00 16/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 14.354 u1: ml/dl st: NotStopd t0: [15:28:00 16/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [15:28:00 16/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 30 rs: Final st: NotStopd t0: [15:28:00 16/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 61 u1: mmHg rs: Final st: NotStopd t0: [15:28:00 16/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 102 u1: mmHg rs: Final st: NotStopd t0: [15:28:00 16/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.28 rs: Final st: NotStopd t0: [15:28:00 16/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 97 u1: % rs: Final st: NotStopd
t0: [15:32:00 16/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd t0: [15:32:00 16/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 14.8624 u1: ml/dl st: NotStopd t0: [15:32:00 16/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 208 rs: Final st: NotStopd t0: [15:32:00 16/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 rs: Final st: NotStopd t0: [15:32:00 16/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [15:32:00 16/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 29 rs: Final st: NotStopd t0: [15:32:00 16/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 53 u1: mmHg rs: Final st: NotStopd t0: [15:32:00 16/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 266 u1: mmHg rs: Final st: NotStopd t0: [15:32:00 16/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd t0: [15:32:00 16/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 208 rs: Final st: NotStopd t0: [15:32:00 16/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 rs: Final st: NotStopd
t0: [12:00:00 16/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [15:00:00 16/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [15:39:00 16/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [15:39:00 16/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [15:39:00 16/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 12 t0: [15:39:00 16/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [15:39:00 16/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [15:39:00 16/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [15:39:00 16/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [15:39:00 16/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [15:39:00 16/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [15:39:00 16/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [15:39:00 16/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.8 u1: L/min st: NotStopd t0: [15:39:00 16/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [15:39:00 16/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [15:39:00 16/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [15:39:00 16/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [15:39:00 16/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [15:39:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [15:39:00 16/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 450 u1: ml/B st: NotStopd t0: [15:39:00 16/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [15:39:00 16/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [15:39:00 16/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [15:39:00 16/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [15:39:00 16/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [15:39:00 16/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [12:00:00 16/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [14:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [14:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [14:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [14:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [14:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [14:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [15:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [15:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [15:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [15:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 16/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 16/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 16/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 16/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 16/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 16/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 16/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 16/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 16/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 16/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 16/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 16/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 16/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 16/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [16:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 16/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 16/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [16:00:00 16/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [16:00:00 16/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 16/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 16/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [16:00:00 16/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [16:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [16:00:00 16/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [16:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 16/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [16:00:00 16/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [16:00:00 16/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [16:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [16:00:00 16/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 16/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 16/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 16/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [16:00:00 16/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 16/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 16/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 16/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [14:00:00 16/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [16:00:00 16/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [16:00:00 16/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 220 vu: ml t0: [16:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 360 vu: ml
t0: [14:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [14:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [14:00:00 16/05/2011] 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: [15:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [15:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [15:00:00 16/05/2011] 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 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [16:00:00 16/05/2011] 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: [23:00:00 16/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 220 ap: none
t0: [10:00:00 16/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 16/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 16/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [12:00:00 16/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 16/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [12:00:00 16/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 16/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 16/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 16/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [12:00:00 16/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 16/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 16/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [15:00:00 16/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 16/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [16:00:00 16/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [16:00:00 16/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 16/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 16/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [16:00:00 16/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 16/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 16/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 16/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 16/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [16:00:00 16/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [16:00:00 16/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [16:00:00 16/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 16/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [16:00:00 16/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 16/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [16:00:00 16/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 16/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [16:00:00 16/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 16/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 16/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 16/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 16/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 16/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 16/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 16/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 16/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 16/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 16/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 16/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 16/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 16/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 16/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 16/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 16/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 16/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 16/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [16:00:00 16/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 16/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 16/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [16:00:00 16/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [16:00:00 16/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 16/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 16/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [16:00:00 16/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [16:00:00 16/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 16/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 16/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 16/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [16:00:00 16/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 16/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 16/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 16/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [16:00:00 16/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:30:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:30:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:30:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:30:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:30:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [16:30:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [16:30:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [16:30:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:30:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [16:30:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [16:30:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:30:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:30:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [16:30:00 16/05/2011] 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: [17:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 25 vu: ml t0: [17:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 217.5 vu: ml t0: [17:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 12 vu: ml t0: [17:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 5 vu: ml
t0: [14:00:00 16/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [14:00:00 16/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 16/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 16/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 16/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 16/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 16/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 16/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 16/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 16/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 16/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 16/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [16:00:00 16/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [17:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [17:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [17:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [17:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [17:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [17:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 16/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml nb: 1 t0: [17:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 110 vu: ml
t0: [17:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.25 du: mgmin sv: 100 su: ml rt: IV Drip t0: [17:00:00 16/05/2011] 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: [18:00:00 16/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [18:00:00 16/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 16/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [18:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [18:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [18:00:00 16/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 16/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 16/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:00:00 16/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 16/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 16/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 16/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [18:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 16/05/2011] tf: [00:45:00 19/05/2011] dt: 3285 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [18:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15 vu: ml t0: [18:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [18:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [18:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [18:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [18:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.25 du: mgmin sv: 100 su: ml rt: IV Drip t0: [18:00:00 16/05/2011] 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: [18:00:00 16/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: RN v1: 94 rs: Manual st: NotStopd t0: [18:00:00 16/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: RN v1: 94 rs: Manual st: NotStopd
t0: [19:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 16/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [19:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 16/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [19:00:00 16/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [19:00:00 16/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [19:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 16/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [19:00:00 16/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [19:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 16/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [19:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 16/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [19:00:00 16/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [19:00:00 16/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [19:00:00 16/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [19:00:00 16/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [19:00:00 16/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [19:00:00 16/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [19:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [19:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:00:00 16/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [19:00:00 16/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [19:00:00 16/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [19:00:00 16/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [19:00:00 16/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [19:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 165 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [19:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [19:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 16/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [19:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [19:00:00 16/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [19:00:00 16/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [19:00:00 16/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [19:00:00 16/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [19:00:00 16/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [19:00:00 16/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [19:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [19:00:00 16/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [19:00:00 16/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [19:00:00 16/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 16/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [19:00:00 16/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [19:00:00 16/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [19:00:00 16/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [19:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [19:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15 vu: ml t0: [19:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [19:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 240 vu: ml t0: [19:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [19:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [19:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.25 du: mgmin sv: 100 su: ml rt: IV Drip t0: [19:00:00 16/05/2011] 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: [19:30:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:30:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:30:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:30:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:30:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [19:30:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:30:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 168 u1: mmHg v2: 89 u2: mmHg st: NotStopd t0: [19:30:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 121 u1: mmHg st: NotStopd t0: [19:30:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:30:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [19:30:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:30:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [19:30:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [19:30:00 16/05/2011] 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: [19:00:00 16/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [19:00:00 16/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [19:00:00 16/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [19:00:00 16/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [19:00:00 16/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [19:00:00 16/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [19:00:00 16/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [19:00:00 16/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [20:00:00 16/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 16/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 16/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 16/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 16/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 16/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 16/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 16/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 16/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [20:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 16/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 16/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 16/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [20:00:00 16/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 16/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 16/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 16/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 16/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 16/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 16/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 16/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 16/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [20:00:00 16/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 16/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [20:00:00 16/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 16/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 16/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [20:00:00 16/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 16/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 16/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 16/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 16/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 16/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 16/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [20:00:00 16/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 16/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [20:00:00 16/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 16/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [20:00:00 16/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 16/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 16/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 16/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [20:00:00 16/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [20:00:00 16/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [20:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 22.5 vu: ml t0: [20:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [20:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [20:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [20:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [20:00:00 16/05/2011] 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: [19:00:00 16/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [19:00:00 16/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [19:00:00 16/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [19:00:00 16/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [20:00:00 16/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [20:00:00 16/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: Serosanguinous v2: Small st: NotStopd t0: [20:00:00 16/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [20:00:00 16/05/2011] id: Untoward Effect el: 0 cu: MICU cg: RN v1: None st: NotStopd
t0: [20:00:00 16/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [20:00:00 16/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 12 t0: [20:00:00 16/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 16/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [20:00:00 16/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 16/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 16/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:00:00 16/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:00:00 16/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:00:00 16/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [20:00:00 16/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 6.7 u1: L/min st: NotStopd t0: [20:00:00 16/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Trach Mask st: NotStopd t0: [20:00:00 16/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 16/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 16/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [20:00:00 16/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [20:00:00 16/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 16/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [20:00:00 16/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 16/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 449 u1: ml/B st: NotStopd t0: [20:00:00 16/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 16/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [20:00:00 16/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [20:00:00 16/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 16/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [21:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 16/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [21:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [21:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [21:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [21:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 13 u1: BPM st: NotStopd t0: [21:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 16/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [21:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [21:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [21:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [21:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [21:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [21:00:00 16/05/2011] 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: [22:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [22:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [22:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [22:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [22:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 16/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [22:00:00 16/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [22:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [22:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [22:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [22:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [22:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mgmin sv: 100 su: ml rt: IV Drip t0: [22:00:00 16/05/2011] 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: [20:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [21:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [22:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml
t0: [23:00:00 16/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 16/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 16/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 16/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 16/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 16/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 16/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [23:00:00 16/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 16/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 166 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [23:00:00 16/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 119 u1: mmHg st: NotStopd t0: [23:00:00 16/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 16/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [23:00:00 16/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 16/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 16/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 16/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [23:00:00 16/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [23:00:00 16/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [23:00:00 16/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [23:00:00 16/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [23:00:00 16/05/2011] 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: [23:00:00 16/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 10 cv: 60 ap: none
t0: [23:00:00 16/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml
t0: [22:00:00 16/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [22:00:00 16/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 16/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 16/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 16/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 16/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 16/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 16/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 16/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 16/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd
t0: [20:00:00 16/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 16/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT u1: lpm st: NotStopd t0: [00:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [00:00:00 17/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 17/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 16 t0: [00:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 17/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [00:00:00 17/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [00:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 17/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [00:00:00 17/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 17/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [00:00:00 17/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [00:00:00 17/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.7 u1: L/min st: NotStopd t0: [00:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Trach Mask st: NotStopd t0: [00:00:00 17/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 17/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 17/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [00:00:00 17/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [00:00:00 17/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [00:00:00 17/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 413 u1: ml/B st: NotStopd t0: [00:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [00:00:00 17/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [00:00:00 17/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
tf: [23:00:00 17/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 0 dn: 1 m1: Furosemide v1: 40 u1: mg
t0: [00:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 111 u1: BPM st: NotStopd t0: [00:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 160 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [00:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [00:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [00:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [00:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [00:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [00:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 160 vu: ml t0: [00:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml t0: [00:30:00 17/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml
t0: [00:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [00:00:00 17/05/2011] 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: [00:00:00 17/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 17/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 17/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 17/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 17/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 17/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 17/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 17/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 17/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 17/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 17/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 17/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 17/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 17/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 17/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 17/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 17/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 17/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 17/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [00:00:00 17/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 17/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: Serous v2: Moderate st: NotStopd t0: [00:00:00 17/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [00:00:00 17/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 17/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 17/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 17/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 17/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 17/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 17/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 17/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 17/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 17/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 17/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 17/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 17/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 17/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 17/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 17/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 17/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 17/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [00:00:00 17/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 17/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 17/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 17/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 17/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 17/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 17/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [00:00:00 17/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 17/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 17/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [00:00:00 17/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 17/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 17/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 17/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 17/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [00:00:00 17/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 17/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [00:00:00 17/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 17/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [00:00:00 17/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 17/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 17/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Not Applicable v2: Negative st: NotStopd t0: [00:00:00 17/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [21:00:00 16/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 16/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 16/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 16/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 16/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [21:00:00 16/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 16/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [21:00:00 16/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [00:00:00 17/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 17/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 17/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 17/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [00:00:00 17/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 17/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 17/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 17/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 17/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 17/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 17/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 17/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 17/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 17/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 17/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 17/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 17/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:00:00 17/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd
t0: [00:00:00 17/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 17/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.9444 u1: Deg. C st: NotStopd t0: [00:00:00 17/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.5 u1: Deg. F st: NotStopd t0: [01:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [01:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [01:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [01:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [01:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [01:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [01:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [01:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [01:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 400 vu: ml t0: [01:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [01:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [01:00:00 17/05/2011] 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: [02:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [02:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [02:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [02:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [02:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [02:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [02:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [02:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [02:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 500 vu: ml t0: [02:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [02:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [02:00:00 17/05/2011] 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: [03:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 17/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [03:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [03:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [03:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [03:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 13 u1: BPM st: NotStopd t0: [03:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [03:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [03:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [03:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [03:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 425 vu: ml t0: [03:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [03:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [03:00:00 17/05/2011] 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: [02:00:00 17/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [02:00:00 17/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 17/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 17/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 17/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 17/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 17/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 17/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 17/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 17/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd
t0: [04:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 17/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [04:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [04:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [04:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [04:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [04:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [04:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [04:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [04:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 420 vu: ml t0: [04:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [04:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [04:00:00 17/05/2011] 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: [04:21:00 17/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd t0: [04:21:00 17/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 3 rs: Final st: NotStopd t0: [04:21:00 17/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 30 rs: Final st: NotStopd t0: [04:21:00 17/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 46 u1: mmHg rs: Final st: NotStopd t0: [04:21:00 17/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 107 u1: mmHg rs: Final st: NotStopd t0: [04:21:00 17/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd
t0: [04:21:00 17/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 104 rs: Final st: NotStopd t0: [04:21:00 17/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 104 rs: Final st: NotStopd t0: [04:21:00 17/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 98 u1: % rs: Final st: NotStopd
t0: [04:00:00 17/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 17/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 17/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 17/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 17/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 17/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 17/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 17/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 17/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 17/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 17/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 17/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 17/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 17/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [04:00:00 17/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 17/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 17/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 17/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 17/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [04:00:00 17/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 17/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: Serous v2: Moderate st: NotStopd t0: [04:00:00 17/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [04:00:00 17/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 17/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 17/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 17/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 17/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 17/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 17/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 17/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 17/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 17/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 17/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 17/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 17/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 17/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [04:00:00 17/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 17/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 17/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [04:00:00 17/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 17/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 17/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [04:00:00 17/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 17/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 17/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [04:00:00 17/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 17/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 17/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 17/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 17/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [04:00:00 17/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [04:00:00 17/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [04:00:00 17/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 17/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [04:00:00 17/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 17/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 17/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Not Applicable v2: Negative st: NotStopd t0: [04:00:00 17/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [00:00:00 17/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [00:00:00 17/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 100 rs: Manual st: NotStopd
t0: [04:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [04:00:00 17/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 88.1356 u1: units st: NotStopd t0: [04:00:00 17/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 16 t0: [04:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 17/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [04:00:00 17/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [04:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 17/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [04:00:00 17/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [04:00:00 17/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:00:00 17/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [04:00:00 17/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 6.7 u1: L/min st: NotStopd t0: [04:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Trach Mask st: NotStopd t0: [04:00:00 17/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 17/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 17/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 8 u1: . st: NotStopd t0: [04:00:00 17/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 88.1356 u1: units st: NotStopd t0: [04:00:00 17/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [04:00:00 17/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:00:00 17/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [04:00:00 17/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.295 u1: L st: NotStopd t0: [04:00:00 17/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 449 u1: ml/B st: NotStopd t0: [04:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [04:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [04:00:00 17/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [04:15:00 17/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.9 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 8.9 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 34.2 u1: % rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 11.6 u1: gm/dl rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 169 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.94 u1: /mic l rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.9 rs: Final st: NotStopd t0: [04:21:00 17/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 15.5648 u1: ml/dl st: NotStopd
t0: [05:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 17/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [05:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 160 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [05:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [05:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [05:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [05:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [05:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [05:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 400 vu: ml t0: [05:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [05:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [05:00:00 17/05/2011] 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: [04:00:00 17/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 17/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd
t0: [04:15:00 17/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 u1: mEq/L rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 u1: mEq/L rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [04:15:00 17/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd
t0: [00:00:00 17/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 17/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 17/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 17/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 17/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 17/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 17/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 17/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 17/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 17/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 17/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [06:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [06:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [06:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [06:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [06:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 17/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 120 vu: ml t0: [06:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [06:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [06:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [06:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [23:00:00 16/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [00:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [01:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [02:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [03:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [04:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [05:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [06:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [06:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [06:00:00 17/05/2011] 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: [23:00:00 17/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 120 ap: none
t0: [04:00:00 17/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 17/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 17/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 17/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 17/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [06:00:00 17/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 17/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 17/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 17/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 17/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 17/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 17/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 17/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 17/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd
t0: [04:00:00 17/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 17/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 17/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [04:00:00 17/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 17/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 17/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 17/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 17/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 17/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 17/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd
t0: [03:00:00 17/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [04:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [05:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [06:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml
t0: [06:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 500 vu: ml
t0: [00:00:00 17/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Medium t0: [06:00:00 17/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 60 vu: ml
t0: [23:00:00 17/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [07:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [07:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [07:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [07:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [07:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [07:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [07:00:00 17/05/2011] 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
tf: [12:00:00 17/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metoprolol v1: 50 u1: mg
t0: [08:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: CoWork v1: 104 u1: BPM st: NotStopd t0: [08:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: CoWork v1: 154 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [08:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: CoWork v1: 27 u1: BPM st: NotStopd t0: [08:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: CoWork v1: 97 u1: % st: NotStopd t0: [08:00:00 17/05/2011] id: Temp. Site el: 0 cu: MICU cg: CoWork v1: Oral st: NotStopd t0: [08:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: CoWork v1: 1 u1: kg st: NotStopd
t0: [08:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: CoWork vo: 242 vu: ml
t0: [08:00:00 17/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 17/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [08:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 17/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 17/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 17/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 17/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 17/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 17/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 17/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 17/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 17/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 17/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 17/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 17/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 17/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 17/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 17/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [08:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 17/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 17/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [08:00:00 17/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 17/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 17/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 109 u1: mmHg st: NotStopd t0: [08:00:00 17/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [08:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 17/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [08:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [08:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [08:00:00 17/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [08:00:00 17/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 17/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [07:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 90 vu: ml t0: [08:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 4 vu: ml t0: [08:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 2 vu: ml
t0: [08:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [08:00:00 17/05/2011] 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: [08:00:00 17/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 17/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 17/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 17/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 17/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 17/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 17/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 17/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 17/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [08:00:00 17/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 17/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 17/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 17/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 17/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 17/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 17/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 17/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 17/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 17/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 17/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 17/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [08:00:00 17/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 17/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 17/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 17/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 17/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 17/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [08:00:00 17/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 17/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 17/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 17/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 17/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 17/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 17/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 17/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 17/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 17/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 17/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 17/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 17/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 17/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [08:00:00 17/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 17/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 17/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 17/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 17/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 17/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 17/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 17/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 17/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 17/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 17/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 17/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Not Applicable v2: Negative st: NotStopd
t0: [07:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 450 vu: ml
t0: [08:00:00 17/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [08:00:00 17/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd
t0: [08:00:00 17/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml
t0: [08:00:00 17/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [09:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [09:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [09:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 110 u1: BPM st: NotStopd t0: [09:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [09:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [09:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [09:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 109 u1: mmHg st: NotStopd t0: [09:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [09:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [09:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [09:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [09:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [09:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [09:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [09:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [09:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 320 vu: ml t0: [09:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [09:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [09:00:00 17/05/2011] 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: [09:10:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: SRT v1: Tracheostomy st: NotStopd t0: [09:10:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: SRT v1: 3 v2: 12 st: NotStopd t0: [09:10:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: SRT v1: Trach Mask st: NotStopd t0: [09:10:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: SRT v1: 98 u1: % st: NotStopd
t0: [09:00:00 17/05/2011] id: high exhale MV el: 0 cu: MICU cg: SRT v1: 14 t0: [09:00:00 17/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: SRT v1: 30 u1: cmH2O st: NotStopd t0: [09:00:00 17/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: SRT v1: 40 u1: BPM st: NotStopd t0: [09:00:00 17/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: SRT v1: 35.1 u1: Deg. C st: NotStopd t0: [09:00:00 17/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: SRT v1: 7 st: NotStopd t0: [09:00:00 17/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: SRT v1: 7 u1: cmH2O st: NotStopd t0: [09:00:00 17/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: SRT v1: 9.04 u1: L/min st: NotStopd t0: [09:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: SRT st: NotStopd t0: [09:00:00 17/05/2011] id: PEEP Set el: 0 cu: MICU cg: SRT v1: 5 u1: cmH2O st: NotStopd t0: [09:00:00 17/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: SRT v1: 20 st: NotStopd t0: [09:00:00 17/05/2011] id: Pressure Support el: 0 cu: MICU cg: SRT v1: 8 u1: . st: NotStopd t0: [09:00:00 17/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: SRT v1: 31 u1: BPM st: NotStopd t0: [09:00:00 17/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: SRT v1: 2 u1: cmH2O st: NotStopd t0: [09:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: SRT v1: 98 u1: % st: NotStopd t0: [09:00:00 17/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: SRT v1: 411 u1: ml/B st: NotStopd t0: [09:00:00 17/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: SRT v1: 411 u1: ml/B st: NotStopd t0: [09:00:00 17/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: SRT v1: CPAP+PS st: NotStopd
t0: [09:00:00 17/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: SRT v1: 4 v2: Combivent st: NotStopd t0: [09:00:00 17/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: SRT v1: Tan v2: Thick st: NotStopd t0: [09:00:00 17/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: SRT v1: Suctioned v2: Copious st: NotStopd
t0: [09:00:00 17/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: SRT v1: Coarse st: NotStopd t0: [09:00:00 17/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: SRT v1: Coarse st: NotStopd t0: [09:00:00 17/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: SRT v1: Coarse st: NotStopd t0: [09:00:00 17/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: SRT v1: Coarse st: NotStopd t0: [09:00:00 17/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: SRT v1: Regular st: NotStopd
t0: [09:00:00 17/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd
t0: [09:10:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [09:10:00 17/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [09:10:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [09:10:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [09:10:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [09:10:00 17/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [09:10:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd
t0: [10:00:00 17/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [10:00:00 17/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [10:00:00 17/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 17/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [10:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [10:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 17/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [10:00:00 17/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 17/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 17/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [10:00:00 17/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 17/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [10:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 17/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [10:00:00 17/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [10:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 17/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [10:00:00 17/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [10:00:00 17/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [10:00:00 17/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [10:00:00 17/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 17/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [10:00:00 17/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [10:00:00 17/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [10:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 110 u1: BPM st: NotStopd t0: [10:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 17/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [10:00:00 17/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [10:00:00 17/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [10:00:00 17/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [10:00:00 17/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [10:00:00 17/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 17/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 17/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [10:00:00 17/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [10:00:00 17/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: Serous v2: Scant st: NotStopd t0: [10:00:00 17/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [10:00:00 17/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [10:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [10:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 17/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [10:00:00 17/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [10:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [10:00:00 17/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [10:00:00 17/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [10:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 162 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [10:00:00 17/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [10:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 116 u1: mmHg st: NotStopd t0: [10:00:00 17/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [10:00:00 17/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 17/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [10:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 17/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 17/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 17/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [10:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [10:00:00 17/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 17/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 17/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 17/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 17/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [10:00:00 17/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [10:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [10:00:00 17/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [10:00:00 17/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [10:00:00 17/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [10:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [10:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [10:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [10:00:00 17/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [10:00:00 17/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [10:00:00 17/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [10:00:00 17/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [10:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 17/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [10:00:00 17/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [10:00:00 17/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [10:00:00 17/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [10:00:00 17/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [10:00:00 17/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [10:00:00 17/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [10:00:00 17/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [10:00:00 17/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [10:00:00 17/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [10:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [10:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [10:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [10:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml t0: [10:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [10:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [10:00:00 17/05/2011] 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: [11:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [11:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 112 u1: BPM st: NotStopd t0: [11:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [11:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [11:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 166 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [11:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 121 u1: mmHg st: NotStopd t0: [11:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [11:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [11:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [11:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [11:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [11:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [11:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [11:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [11:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [11:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 400 vu: ml t0: [11:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [11:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [11:00:00 17/05/2011] 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 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.5 u1: torr st: NotStopd t0: [12:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [12:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 3 v2: 12 st: NotStopd t0: [12:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: rrt v1: Trach Mask st: NotStopd t0: [12:00:00 17/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: rrt v1: 10 u1: lpm st: NotStopd t0: [12:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: rrt v1: 94 u1: % st: NotStopd
t0: [10:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [11:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [12:00:00 17/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [12:00:00 17/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 17/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 17/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [12:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 17/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 17/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 17/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 17/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 17/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 17/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 17/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 17/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 17/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 17/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 17/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 17/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 17/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 17/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 17/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [12:00:00 17/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 17/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 17/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 17/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [12:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 17/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [12:00:00 17/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [12:00:00 17/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 17/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [12:00:00 17/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 17/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 17/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 17/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [12:00:00 17/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [12:00:00 17/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 17/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 17/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 17/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 17/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 17/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 17/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 17/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 157 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [12:00:00 17/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [12:00:00 17/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [12:00:00 17/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 17/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 17/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 17/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 17/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 17/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 17/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 17/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [12:00:00 17/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 17/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 17/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 17/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 17/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 17/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [12:00:00 17/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 17/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 17/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 17/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 17/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 17/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 17/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [12:00:00 17/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [12:00:00 17/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [12:00:00 17/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 17/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 17/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 17/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 17/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [12:00:00 17/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 17/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [12:00:00 17/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [12:00:00 17/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [12:00:00 17/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [12:00:00 17/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [12:00:00 17/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [12:00:00 17/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [12:00:00 17/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [12:00:00 17/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 17/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Changed st: NotStopd t0: [12:00:00 17/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Not Applicable v2: Negative st: NotStopd t0: [12:00:00 17/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [12:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [12:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [12:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [12:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 210 vu: ml t0: [12:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [12:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [12:00:00 17/05/2011] 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: [12:30:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: SRT v1: 3 v2: 26 st: NotStopd t0: [12:30:00 17/05/2011] id: Cuff Leak el: 0 cu: MICU cg: SRT v1: Other/Remarks st: NotStopd t0: [12:30:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: SRT v1: 0.5 u1: torr st: NotStopd t0: [12:30:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: SRT v1: Tracheostomy st: NotStopd t0: [12:30:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: SRT v1: 3 v2: 12 st: NotStopd t0: [12:30:00 17/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: SRT v1: 4 v2: Combivent st: NotStopd t0: [12:30:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: SRT v1: Hi Flow Neb st: NotStopd t0: [12:30:00 17/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: SRT v1: 15 u1: lpm st: NotStopd t0: [12:30:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: SRT v1: 95 u1: % st: NotStopd t0: [12:30:00 17/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: SRT v1: Tan v2: Thick st: NotStopd t0: [12:30:00 17/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: SRT v1: Suctioned v2: Copious st: NotStopd t0: [12:30:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: SRT v1: Yes v2: No st: NotStopd t0: [12:30:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: SRT v1: #6 st: NotStopd t0: [12:30:00 17/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: SRT v1: Deflated st: NotStopd t0: [12:30:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: SRT v1: Shiley st: NotStopd
tf: [15:00:00 17/05/2011] pt: Unit Dose rt: IM fr: BID:PRN m1: Haloperidol v1: 0.5-1 u1: mg
t0: [12:00:00 17/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 144 rs: Manual st: NotStopd t0: [13:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [13:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [13:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [13:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [13:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [13:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [13:00:00 17/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [13:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [13:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 116 u1: mmHg st: NotStopd t0: [13:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [13:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [13:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [13:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [13:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [13:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [13:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [13:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [13:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [13:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [13:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [13:00:00 17/05/2011] 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: [13:00:00 17/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [14:00:00 17/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [14:00:00 17/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [14:00:00 17/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 17/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [14:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [14:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 17/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 17/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 17/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 17/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [14:00:00 17/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 17/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [14:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 17/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [14:00:00 17/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 17/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [14:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [14:00:00 17/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [14:00:00 17/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 17/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 17/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [14:00:00 17/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [14:00:00 17/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [14:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [14:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 17/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [14:00:00 17/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [14:00:00 17/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [14:00:00 17/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [14:00:00 17/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [14:00:00 17/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [14:00:00 17/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [14:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [14:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 17/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [14:00:00 17/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [14:00:00 17/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [14:00:00 17/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [14:00:00 17/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 158 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [14:00:00 17/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [14:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [14:00:00 17/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 17/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 17/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 17/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [14:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [14:00:00 17/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 17/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 17/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 17/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 17/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [14:00:00 17/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [14:00:00 17/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [14:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 92 u1: % st: NotStopd t0: [14:00:00 17/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [14:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [14:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [14:00:00 17/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 17/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [14:00:00 17/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 17/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [14:00:00 17/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [14:00:00 17/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [14:00:00 17/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [14:00:00 17/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [14:00:00 17/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [14:00:00 17/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [14:00:00 17/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [14:00:00 17/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [14:00:00 17/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [14:00:00 17/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 17/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 17/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Not Applicable v2: Negative st: NotStopd t0: [14:00:00 17/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [14:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [14:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [14:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [14:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [14:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [14:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [14:00:00 17/05/2011] 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: [15:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [15:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [15:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 107 u1: BPM st: NotStopd t0: [15:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [15:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [15:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [15:00:00 17/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [15:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 164 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [15:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [15:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [15:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [15:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [15:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [15:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [15:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [15:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 400 vu: ml t0: [14:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 260 vu: ml t0: [15:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [15:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [15:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [15:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 210 vu: ml t0: [15:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [15:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [15:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [15:00:00 17/05/2011] 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 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.5 u1: torr st: NotStopd t0: [16:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [16:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 3 v2: 12 st: NotStopd t0: [16:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: rrt v1: Hi Flow Neb st: NotStopd t0: [16:00:00 17/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: rrt v1: 15 u1: lpm st: NotStopd t0: [16:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: rrt v1: 95 u1: % st: NotStopd
tf: [05:00:00 18/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metoprolol v1: 75 u1: mg tf: [10:00:00 19/05/2011] pt: Unit Dose rt: IV fr: TID fs: 08, 16, 22 dn: 3 m1: Haloperidol v1: 0.5 u1: mg tf: [14:00:00 19/05/2011] pt: Unit Dose rt: IV fr: BID:PRN m1: Haloperidol v1: 0.5-1 u1: mg
t0: [16:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 17/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [16:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 102 u1: BPM st: NotStopd t0: [16:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [16:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [16:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [16:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 17/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [17:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [17:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 166 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [17:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [17:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [17:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [17:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [16:00:00 17/05/2011] 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: [17:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [17:00:00 17/05/2011] 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 17/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 17/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 17/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 17/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [16:00:00 17/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd
t0: [18:00:00 17/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWork v1: 174 rs: Manual st: NotStopd
t0: [15:00:00 17/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [15:00:00 17/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [16:00:00 17/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [16:00:00 17/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 17/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [16:00:00 17/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 17/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 17/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 17/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 17/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 17/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 17/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 17/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [16:00:00 17/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [16:00:00 17/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 17/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 17/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 17/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 17/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 17/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 17/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 17/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 17/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [16:00:00 17/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 17/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 17/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [16:00:00 17/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [16:00:00 17/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 17/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [16:00:00 17/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [16:00:00 17/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 17/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 17/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 17/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 17/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [16:00:00 17/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 17/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [17:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [17:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [17:00:00 17/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [17:00:00 17/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 17/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [17:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [17:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [17:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [17:00:00 17/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [17:00:00 17/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:00:00 17/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [17:00:00 17/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [17:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [17:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [17:00:00 17/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [17:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [18:00:00 17/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [18:00:00 17/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [18:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 17/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [18:00:00 17/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 17/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [18:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 17/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [18:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 17/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [18:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [18:00:00 17/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [18:00:00 17/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [18:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 95 u1: BPM st: NotStopd t0: [18:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 17/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [18:00:00 17/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [18:00:00 17/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [18:00:00 17/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [18:00:00 17/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [18:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [18:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 17/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 17/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 17/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [18:00:00 17/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [18:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [18:00:00 17/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [18:00:00 17/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [18:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 160 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [18:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [18:00:00 17/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 17/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 17/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 17/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 17/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [18:00:00 17/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 17/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 17/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 17/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 17/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [18:00:00 17/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [18:00:00 17/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [18:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [18:00:00 17/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [18:00:00 17/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [18:00:00 17/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [18:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [18:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [18:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [18:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [18:00:00 17/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [18:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 17/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [19:00:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [19:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 17/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 25 u1: mmHg st: NotStopd t0: [19:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [19:00:00 17/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [19:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [19:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:00:00 17/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [19:00:00 17/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [19:00:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [19:00:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [19:00:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [19:00:00 17/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [19:00:00 17/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [19:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [19:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [19:00:00 17/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [19:00:00 17/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [19:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [19:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [19:00:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [19:00:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [19:00:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [19:00:00 17/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [19:00:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [19:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [16:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [16:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [16:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml t0: [17:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [17:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [17:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [17:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [17:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml t0: [18:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [18:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [18:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [18:00:00 17/05/2011] id: Chest Tubes Right Pleural 1 el: 1 cu: MICU cg: RN vo: 8 vu: ml t0: [18:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml t0: [19:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [19:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [19:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [19:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [19:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml t0: [19:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [18:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [18:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [18:00:00 17/05/2011] 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: [19:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [19:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [19:00:00 17/05/2011] 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: [23:00:00 17/05/2011] dt: 24 id: Chest Tube Out Total el: 2 cu: MICU cg: RN cv: 68 ap: none
t0: [20:24:00 17/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [20:24:00 17/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:24:00 17/05/2011] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd t0: [20:24:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [20:24:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:24:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:24:00 17/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:24:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Hi Flow Neb st: NotStopd t0: [20:24:00 17/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT v1: 15 u1: lpm st: NotStopd t0: [20:24:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [20:24:00 17/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Brown v2: Thick st: NotStopd t0: [20:24:00 17/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [20:24:00 17/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:24:00 17/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [20:24:00 17/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:24:00 17/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [20:24:00 17/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 17/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 17/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 1 u1: mmHg st: NotStopd t0: [20:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 17/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 101 u1: BPM st: NotStopd t0: [20:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 163 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [20:00:00 17/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [20:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [20:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [20:00:00 17/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 17/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [20:00:00 17/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [20:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [20:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [20:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 245 vu: ml t0: [20:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [20:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [20:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [20:00:00 17/05/2011] 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: [21:00:00 17/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [21:00:00 17/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 17/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [21:00:00 17/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [21:00:00 17/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [21:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 17/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [21:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 17/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [21:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 17/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [21:00:00 17/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [21:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 17/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [21:00:00 17/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [21:00:00 17/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [21:00:00 17/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [21:00:00 17/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Bilious st: NotStopd t0: [21:00:00 17/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [21:00:00 17/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [21:00:00 17/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [21:00:00 17/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 100 u1: BPM st: NotStopd t0: [21:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 17/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [21:00:00 17/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [21:00:00 17/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 17/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [21:00:00 17/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [21:00:00 17/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 17/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [21:00:00 17/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 17/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 17/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 17/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [21:00:00 17/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [21:00:00 17/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 17/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 17/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [21:00:00 17/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [21:00:00 17/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 17/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [21:00:00 17/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 1 st: NotStopd t0: [21:00:00 17/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 164 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [21:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [21:00:00 17/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [21:00:00 17/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 17/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 17/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 17/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 17/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [21:00:00 17/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 17/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [21:00:00 17/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [21:00:00 17/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [21:00:00 17/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [21:00:00 17/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 17/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 17/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [21:00:00 17/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [21:00:00 17/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [21:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [21:00:00 17/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 17/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [21:00:00 17/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 17/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [21:00:00 17/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 17/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [21:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 17/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Restless st: NotStopd t0: [21:00:00 17/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [21:00:00 17/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [21:00:00 17/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [21:00:00 17/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [21:00:00 17/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [21:00:00 17/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [21:00:00 17/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [21:00:00 17/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [21:00:00 17/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [21:00:00 17/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 17/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [21:00:00 17/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Negative v2: Negative st: NotStopd t0: [21:00:00 17/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [20:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [20:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [21:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [21:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [21:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [21:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [21:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml t0: [21:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [21:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [21:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [21:00:00 17/05/2011] 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: [22:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 17/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [22:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [22:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 163 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [22:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [22:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [22:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [22:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [22:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [22:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [22:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [22:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [22:00:00 17/05/2011] 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: [22:00:00 17/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [22:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml
t0: [23:00:00 17/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 17/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [23:00:00 17/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 17/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 17/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 17/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 17/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 17/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [23:00:00 17/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 17/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 169 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [23:00:00 17/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 119 u1: mmHg st: NotStopd t0: [23:00:00 17/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 17/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [23:00:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 17/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 17/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [23:00:00 17/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [23:00:00 17/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [23:00:00 17/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [23:00:00 17/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [23:00:00 17/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [23:00:00 17/05/2011] 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: [23:00:00 17/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 53 cv: 1562 ap: none
t0: [23:22:00 17/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [23:22:00 17/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [23:22:00 17/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [23:22:00 17/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [23:22:00 17/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Hi Flow Neb st: NotStopd t0: [23:22:00 17/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT v1: 15 u1: lpm st: NotStopd t0: [23:22:00 17/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [23:22:00 17/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thin st: NotStopd t0: [23:22:00 17/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd
t0: [00:00:00 18/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWker v1: 133 rs: Manual st: NotStopd
t0: [00:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [00:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 106 u1: BPM st: NotStopd t0: [00:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 163 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [00:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [00:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [00:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [00:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 17/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [00:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [00:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [00:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [00:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [00:00:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [00:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [00:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [00:00:00 18/05/2011] 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: [23:00:00 17/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 80 cv: 80 ap: none t0: [23:00:00 17/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 80 cv: 6242 ap: none t0: [23:00:00 17/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 80 cv: 6310 ap: carryForward
t0: [00:00:00 18/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [01:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [01:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 104 u1: BPM st: NotStopd t0: [01:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 163 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [01:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [01:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [01:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [01:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [01:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [01:00:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [01:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [01:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [01:00:00 18/05/2011] 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: [00:00:00 18/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [02:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 103 u1: BPM st: NotStopd t0: [02:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 162 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [02:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 111 u1: mmHg st: NotStopd t0: [02:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [02:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [03:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [03:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [03:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 162 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [03:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 111 u1: mmHg st: NotStopd t0: [03:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [03:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [23:00:00 17/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [00:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [01:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [01:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [02:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [02:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [02:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [02:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [02:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml t0: [02:00:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml t0: [03:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [03:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [03:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [03:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [03:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [03:00:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [02:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [02:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [02:00:00 18/05/2011] 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: [03:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [03:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [03:00:00 18/05/2011] 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: [23:00:00 17/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 13 cv: 13 ap: none t0: [23:00:00 17/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 93 cv: 2092 ap: none t0: [23:00:00 17/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 40 cv: 410 ap: none t0: [23:00:00 17/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 13 cv: -4218 ap: carryForward t0: [23:00:00 17/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 13 cv: 17432.5 ap: carryForward t0: [23:00:00 18/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: 1663 pv: 550 cv: 550 ap: none t0: [23:00:00 18/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: 1663 pv: -445 cv: -445 ap: none t0: [23:00:00 18/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: 1663 pv: 65 cv: 2455 ap: none t0: [23:00:00 18/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: 1663 pv: 105 cv: 3135 ap: none t0: [23:00:00 18/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: 1663 pv: 40 cv: 540 ap: none t0: [23:00:00 18/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: 1663 pv: 550 cv: 5065 ap: none t0: [23:00:00 18/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: 1663 pv: -445 cv: -1930 ap: carryForward t0: [23:00:00 18/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: 1663 pv: 550 cv: 5065 ap: carryForward t0: [23:00:00 18/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: 1663 pv: -445 cv: 15502.5 ap: carryForward
t0: [04:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [04:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 18/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 103 u1: BPM st: NotStopd t0: [04:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [04:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [04:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [04:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [04:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [04:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [04:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [04:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [04:00:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [04:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [04:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [04:00:00 18/05/2011] 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: [00:00:00 18/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 18/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [00:00:00 18/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [04:00:00 18/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 18/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [04:00:00 18/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [05:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 27 u1: mmHg st: NotStopd t0: [05:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [05:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [05:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [05:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [05:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [05:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [05:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [05:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [05:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml t0: [05:00:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [05:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [05:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [05:00:00 18/05/2011] 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: [04:00:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [04:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [04:00:00 18/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Hi Flow Neb st: NotStopd t0: [04:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT v1: 15 u1: lpm st: NotStopd
t0: [06:00:00 18/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWker v1: 182 rs: Manual st: NotStopd
t0: [04:45:00 18/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.5 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 9.5 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 32.3 u1: % rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.8 u1: gm/dl rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 159 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.65 u1: /mic l rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.5 rs: Final st: NotStopd
t0: [00:00:00 18/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 18/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 18/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 18/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 18/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 18/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 18/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 18/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [00:00:00 18/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 18/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 18/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 18/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 18/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 18/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 18/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 18/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [00:00:00 18/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 18/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 18/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 18/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:00:00 18/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 18/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 18/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 18/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 18/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 18/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 18/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 18/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 18/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [00:00:00 18/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 18/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 18/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 18/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 18/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [01:00:00 18/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [01:00:00 18/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [01:00:00 18/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [01:00:00 18/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [01:00:00 18/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Bilious st: NotStopd t0: [01:00:00 18/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [01:00:00 18/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [01:00:00 18/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [01:00:00 18/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [01:00:00 18/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [01:00:00 18/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [01:00:00 18/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Pink v2: Cloudy st: NotStopd t0: [01:00:00 18/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [01:00:00 18/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [01:00:00 18/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [01:00:00 18/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 18/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [01:00:00 18/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Negative v2: Negative st: NotStopd t0: [01:00:00 18/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [04:00:00 18/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 18/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 18/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 18/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [04:00:00 18/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 18/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 18/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 18/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 18/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 18/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 18/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 18/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 18/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [04:00:00 18/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 18/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 18/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Bilious st: NotStopd t0: [04:00:00 18/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 18/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 18/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 18/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 18/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 18/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [04:00:00 18/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 18/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 18/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 18/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 18/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 18/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 18/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 18/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 18/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [04:00:00 18/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 18/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 18/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 18/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 18/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 18/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 18/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 18/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 18/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 18/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 18/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 18/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 18/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 18/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 18/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 18/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 18/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 18/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 18/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 18/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 18/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 18/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 18/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 18/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [04:00:00 18/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 18/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 18/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 18/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 18/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Pink v2: Cloudy st: NotStopd t0: [04:00:00 18/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 18/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 18/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 18/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 18/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 18/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [04:00:00 18/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 18/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 18/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Negative v2: Negative st: NotStopd t0: [04:00:00 18/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [06:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 26 u1: mmHg st: NotStopd t0: [06:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [06:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 158 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [06:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [06:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [06:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [06:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [06:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [06:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [06:00:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [06:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [06:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [06:00:00 18/05/2011] 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: [06:28:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [06:28:00 18/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Frothy st: NotStopd t0: [06:28:00 18/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd
t0: [06:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml
t0: [04:45:00 18/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 94 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 173 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 u1: mEq/L rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 94 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 173 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 u1: mEq/L rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd
t0: [04:45:00 18/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 rs: Final st: NotStopd t0: [04:45:00 18/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 rs: Final st: NotStopd
t0: [07:00:00 18/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml t0: [07:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [07:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [07:00:00 18/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 80 vu: ml t0: [07:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [07:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2 vu: ml t0: [07:00:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 1 vu: ml
t0: [07:00:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.5 u1: torr st: NotStopd t0: [07:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [07:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 3 v2: 12 st: NotStopd t0: [07:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: rrt v1: Hi Flow Neb st: NotStopd t0: [07:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: rrt v1: 15 u1: lpm st: NotStopd t0: [07:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: rrt v1: 96 u1: % st: NotStopd
t0: [07:54:00 18/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.29 rs: Final st: NotStopd t0: [07:54:00 18/05/2011] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 14.536 u1: ml/dl st: NotStopd t0: [07:54:00 18/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [07:54:00 18/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 36 rs: Final st: NotStopd t0: [07:54:00 18/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 72 u1: mmHg rs: Final st: NotStopd t0: [07:54:00 18/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 114 u1: mmHg rs: Final st: NotStopd t0: [07:54:00 18/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.29 rs: Final st: NotStopd t0: [07:54:00 18/05/2011] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 98 u1: % rs: Final st: NotStopd
tf: [17:00:00 18/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metoprolol v1: 100 u1: mg tf: [07:00:00 19/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 8 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [07:00:00 19/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 8 dn: 1 m1: Magnesium Sulfate v1: 1 u1: gm tf: [07:00:00 19/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 8 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq
t0: [07:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [07:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [07:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [07:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [07:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [07:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:30:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:30:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [07:30:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:30:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:30:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:30:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [07:30:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [07:30:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [07:30:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:30:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [07:30:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [07:30:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 18/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Distraction st: NotStopd t0: [08:00:00 18/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 18/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [08:00:00 18/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 18/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 18/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 18/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 18/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 18/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 18/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 18/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 18/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 18/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 18/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [08:00:00 18/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 18/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 18/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 18/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 18/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 18/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 97 u1: BPM st: NotStopd t0: [08:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 18/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 18/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [08:00:00 18/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 18/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 18/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 18/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 18/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 18/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 18/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 18/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 18/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [08:00:00 18/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 18/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 18/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 18/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 18/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 18/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 18/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 18/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 18/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [08:00:00 18/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [08:00:00 18/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 18/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 18/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [08:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 18/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 18/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 18/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 18/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 18/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [08:00:00 18/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 18/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 18/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 18/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 18/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 18/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 18/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 18/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [08:00:00 18/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 18/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 18/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [08:00:00 18/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [08:00:00 18/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 18/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Pink v2: Cloudy st: NotStopd t0: [08:00:00 18/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 18/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 18/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 18/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 18/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 18/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 18/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 18/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 18/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [08:00:00 18/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 18/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [08:00:00 18/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 18/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 18/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 18/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 18/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Negative v2: Positive st: NotStopd t0: [08:00:00 18/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [07:30:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vu: ml st: Stopped t0: [08:00:00 18/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [08:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [08:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [08:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 1 vu: ml t0: [08:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml t0: [08:00:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 0 vu: ml
t0: [08:00:00 18/05/2011] tf: [14:07:00 24/05/2011] dt: 9007 id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 250 su: ml rt: IV Drip t0: [07:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [07:00:00 18/05/2011] 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: [07:30:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip st: Stopped t0: [07:30:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [07:30:00 18/05/2011] 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: [08:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [08:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [08:00:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [08:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [08:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [08:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [08:00:00 18/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [08:00:00 18/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [08:00:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [08:00:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [08:00:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [09:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [09:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [09:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 97 u1: BPM st: NotStopd t0: [09:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [09:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [09:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [09:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [09:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [09:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [09:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [09:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [09:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [09:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [09:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [09:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml t0: [09:00:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 516 vo: 0 vu: ml st: Stopped
t0: [09:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [09:31:00 18/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.27 rs: Final st: NotStopd t0: [09:31:00 18/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [09:31:00 18/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 35 rs: Final st: NotStopd t0: [09:31:00 18/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 73 u1: mmHg rs: Final st: NotStopd t0: [09:31:00 18/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 129 u1: mmHg rs: Final st: NotStopd t0: [09:31:00 18/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.27 rs: Final st: NotStopd
t0: [09:30:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [09:30:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:30:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [09:30:00 18/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [09:30:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [09:30:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [09:30:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:30:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [09:30:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [09:30:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [09:30:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [09:30:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [09:30:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [09:30:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:30:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [09:30:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [09:30:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [09:30:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [09:30:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [09:30:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [09:30:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [10:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [10:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml
t0: [09:30:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [09:30:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [09:30:00 18/05/2011] 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: [10:00:00 18/05/2011] id: high exhale MV el: 0 cu: MICU cg: rrt v1: 14 t0: [10:00:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.4 u1: torr st: NotStopd t0: [10:00:00 18/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: rrt v1: 30 u1: cmH2O st: NotStopd t0: [10:00:00 18/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: rrt v1: 40 u1: BPM st: NotStopd t0: [10:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [10:00:00 18/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: rrt v1: 35 u1: Deg. C st: NotStopd t0: [10:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 3 v2: 12 st: NotStopd t0: [10:00:00 18/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: rrt v1: 7 st: NotStopd t0: [10:00:00 18/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: rrt v1: 7 u1: cmH2O st: NotStopd t0: [10:00:00 18/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: rrt v1: 8.5 u1: L/min st: NotStopd t0: [10:00:00 18/05/2011] id: PEEP Set el: 0 cu: MICU cg: rrt v1: 5 u1: cmH2O st: NotStopd t0: [10:00:00 18/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: rrt v1: 20 st: NotStopd t0: [10:00:00 18/05/2011] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 8 u1: . st: NotStopd t0: [10:00:00 18/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: rrt v1: 26 u1: BPM st: NotStopd t0: [10:00:00 18/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: rrt v1: 2 u1: cmH2O st: NotStopd t0: [10:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: rrt v1: 100 u1: % st: NotStopd t0: [10:00:00 18/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: rrt v1: 322 u1: ml/B st: NotStopd t0: [10:00:00 18/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: rrt v1: CPAP+PS st: NotStopd t0: [10:00:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: rrt v1: Drager st: NotStopd
t0: [09:30:00 18/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [09:30:00 18/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [10:00:00 18/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [10:00:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [10:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [10:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 18/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 18/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [10:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [10:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [10:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [10:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [10:00:00 18/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [10:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [10:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [10:00:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [10:00:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [10:00:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [10:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [10:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [09:00:00 18/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [09:00:00 18/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [09:00:00 18/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [09:00:00 18/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [09:00:00 18/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [09:00:00 18/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [09:00:00 18/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [09:00:00 18/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 18/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [09:00:00 18/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 18/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [09:00:00 18/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [09:00:00 18/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [10:00:00 18/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [10:00:00 18/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [10:00:00 18/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [10:00:00 18/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [10:00:00 18/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [10:00:00 18/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [10:00:00 18/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [10:00:00 18/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [10:00:00 18/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 18/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [10:00:00 18/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [10:00:00 18/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 18/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [10:00:00 18/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [10:00:00 18/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [10:00:00 18/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [10:00:00 18/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [10:00:00 18/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [10:00:00 18/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [10:00:00 18/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 18/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [10:00:00 18/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [10:00:00 18/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [10:00:00 18/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [10:00:00 18/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 18/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [10:00:00 18/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [10:00:00 18/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [10:00:00 18/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 18/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [10:00:00 18/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 18/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [10:00:00 18/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 18/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 18/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [10:00:00 18/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 18/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 18/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 18/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [10:00:00 18/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [10:00:00 18/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [10:00:00 18/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [10:00:00 18/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [10:00:00 18/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 18/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [10:00:00 18/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [10:00:00 18/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [10:00:00 18/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [10:00:00 18/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [10:00:00 18/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [10:00:00 18/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [10:00:00 18/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [10:00:00 18/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [10:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml
t0: [10:00:00 18/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd
t0: [11:16:00 18/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd t0: [11:16:00 18/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 7 rs: Final st: NotStopd t0: [11:16:00 18/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 37 rs: Final st: NotStopd t0: [11:16:00 18/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 64 u1: mmHg rs: Final st: NotStopd t0: [11:16:00 18/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 131 u1: mmHg rs: Final st: NotStopd t0: [11:16:00 18/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd
t0: [11:00:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [11:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 5 u1: mmHg st: NotStopd t0: [11:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [11:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [11:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [11:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [11:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [11:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [11:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [11:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [11:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [11:00:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [11:00:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [11:00:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [11:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [11:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [11:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [11:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml
t0: [11:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [11:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [12:00:00 18/05/2011] id: high exhale MV el: 0 cu: MICU cg: rrt v1: 14 t0: [12:00:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 18/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: rrt v1: 30 u1: cmH2O st: NotStopd t0: [12:00:00 18/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: rrt v1: 40 u1: BPM st: NotStopd t0: [12:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [12:00:00 18/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: rrt v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 3 v2: 12 st: NotStopd t0: [12:00:00 18/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: rrt v1: 7 st: NotStopd t0: [12:00:00 18/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Combivent st: NotStopd t0: [12:00:00 18/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: rrt v1: 8.4 u1: L/min st: NotStopd t0: [12:00:00 18/05/2011] id: PEEP Set el: 0 cu: MICU cg: rrt v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 18/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: rrt v1: 20 st: NotStopd t0: [12:00:00 18/05/2011] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 12 u1: . st: NotStopd t0: [12:00:00 18/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: rrt v1: 21 u1: BPM st: NotStopd t0: [12:00:00 18/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: rrt v1: 2 u1: cmH2O st: NotStopd t0: [12:00:00 18/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: rrt v1: 446 u1: ml/B st: NotStopd t0: [12:00:00 18/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: rrt v1: CPAP+PS st: NotStopd t0: [12:00:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: rrt v1: Drager st: NotStopd
id: KCL el: 100 cu: MICU cg: RN io: .9% Normal Saline 500.0ml IV Infusions am: 40 du: mEq rt: Intravenous Push id: Magnesium Sulfate el: 100 cu: MICU cg: RN io: .9% Normal Saline 250.0ml IV Infusions am: 3 du: gm rt: Intravenous Push
io: .9% Normal Saline 500.0ml IV Infusions el: 1 cu: MICU cg: RN ra: 100 ru: ml/hr io: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ra: 75 ru: ml/hr
tf: [11:00:00 19/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 12 dn: 1 m1: Magnesium Sulfate v1: 3 u1: gm m2: NS v2: 250 u2: ml tf: [11:00:00 19/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 12 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: NS v2: 500 u2: ml
id: .9% Normal Saline el: 1 cu: MICU cg: RN io: .9% Normal Saline 500.0ml IV Infusions vo: 500 du: ml rt: Intravenous Infusion id: .9% Normal Saline el: 1 cu: MICU cg: RN io: .9% Normal Saline 250.0ml IV Infusions vo: 250 du: ml rt: Intravenous Infusion
t0: [12:00:00 18/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [12:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [12:00:00 18/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 18/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 18/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 18/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 18/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 18/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 18/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 18/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 18/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 18/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 18/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 18/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 18/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 18/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [12:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 18/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [12:00:00 18/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [12:00:00 18/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 18/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [12:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [12:00:00 18/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [12:00:00 18/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [12:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 18/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [12:00:00 18/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [12:00:00 18/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [12:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 85 u1: % st: NotStopd t0: [12:00:00 18/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [12:00:00 18/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [12:00:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [12:00:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [12:00:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [12:00:00 18/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 18/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 18/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [12:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [12:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [12:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [12:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 40 vu: ml
t0: [12:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [12:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [12:00:00 18/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 126 rs: Manual st: NotStopd
t0: [12:00:00 18/05/2011] tf: [16:00:00 18/05/2011] dt: 240 id: .9% Normal Saline 500.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 100 vu: ml nb: 1 t0: [12:00:00 18/05/2011] tf: [15:00:00 18/05/2011] dt: 180 id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml nb: 1
t0: [13:00:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [13:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [13:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [13:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [13:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [13:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [13:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [13:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 159 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [13:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [13:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [13:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [13:00:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [13:00:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [13:00:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [13:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [13:00:00 18/05/2011] id: .9% Normal Saline 500.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 100 vu: ml t0: [13:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [13:00:00 18/05/2011] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [13:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [13:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 25 vu: ml
t0: [13:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [13:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [14:00:00 18/05/2011] id: CT #1 Crepitus el: 0 cu: MICU cg: -1 st: D/C'd t0: [14:00:00 18/05/2011] id: CT #1 Drainage el: 0 cu: MICU cg: -1 st: D/C'd t0: [14:00:00 18/05/2011] id: CT #1 Dressing el: 0 cu: MICU cg: -1 st: D/C'd t0: [14:00:00 18/05/2011] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: -1 st: D/C'd
t0: [14:00:00 18/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [14:00:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [14:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [14:00:00 18/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 18/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 18/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [14:00:00 18/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [14:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 18/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [14:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 18/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 18/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [14:00:00 18/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [14:00:00 18/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 18/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 18/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [14:00:00 18/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [14:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [14:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [14:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 18/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [14:00:00 18/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 18/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [14:00:00 18/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [14:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [14:00:00 18/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [14:00:00 18/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 162 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [14:00:00 18/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [14:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [14:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 18/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [14:00:00 18/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 18/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [14:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [14:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [14:00:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [14:00:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [14:00:00 18/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [14:00:00 18/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 18/05/2011] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd
t0: [14:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [14:00:00 18/05/2011] id: .9% Normal Saline 500.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 100 vu: ml t0: [14:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [14:00:00 18/05/2011] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [14:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [14:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml
t0: [14:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [14:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip
tf: [14:00:00 19/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 15 dn: 1 m1: Furosemide v1: 40 u1: mg
t0: [15:00:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [15:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [15:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [15:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [15:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [15:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [15:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [15:00:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [15:00:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [15:00:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd
t0: [15:00:00 18/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [15:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [15:00:00 18/05/2011] id: .9% Normal Saline 500.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 100 vu: ml t0: [15:00:00 18/05/2011] id: .9% Normal Saline 100.0ml + 100mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [15:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [15:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml
tf: [17:00:00 18/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Captopril v1: 25 u1: mg
t0: [15:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 18/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [15:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 18/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [15:00:00 18/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [15:00:00 18/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 164 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [15:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [15:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [15:00:00 18/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 18/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 18/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [16:00:00 18/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 18/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [16:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 18/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 18/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 18/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 18/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 18/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 18/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 18/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 18/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 18/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 18/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [16:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 18/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [16:00:00 18/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [16:00:00 18/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [16:00:00 18/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [16:00:00 18/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [16:00:00 18/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [16:00:00 18/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [16:00:00 18/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [16:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 18/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 18/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 18/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 18/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [16:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [16:00:00 18/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 158 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [16:00:00 18/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [16:00:00 18/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 18/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 18/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 18/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 18/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [16:00:00 18/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 18/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 18/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 18/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 18/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [16:00:00 18/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 18/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 18/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 18/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 18/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [16:00:00 18/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [16:00:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [16:00:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [16:00:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [16:00:00 18/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [16:00:00 18/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 18/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [16:00:00 18/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 18/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 18/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 18/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [16:00:00 18/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [16:00:00 18/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [16:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [16:00:00 18/05/2011] tf: [11:01:00 19/05/2011] dt: 1141 id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [16:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [16:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 350 vu: ml
t0: [15:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [15:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [16:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [16:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [16:03:00 18/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.45 rs: Final st: NotStopd t0: [16:03:00 18/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 7 rs: Final st: NotStopd t0: [16:03:00 18/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 32 rs: Final st: NotStopd t0: [16:03:00 18/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [16:03:00 18/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 126 u1: mmHg rs: Final st: NotStopd t0: [16:03:00 18/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.45 rs: Final st: NotStopd
t0: [17:00:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [17:00:00 18/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [17:00:00 18/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14 t0: [17:00:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 18/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [17:00:00 18/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [17:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [17:00:00 18/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [17:00:00 18/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [17:00:00 18/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [17:00:00 18/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 18/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 18/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [17:00:00 18/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [17:00:00 18/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [17:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [17:00:00 18/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 399 u1: ml/B st: NotStopd t0: [17:00:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [17:00:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [17:00:00 18/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [17:00:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [17:00:00 18/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [17:00:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [16:00:00 18/05/2011] id: PT el: 0 cu: MICU cg: 1663 v1: 12.4 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 27.7 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 12.4 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 27.7 rs: Final st: NotStopd
t0: [16:00:00 18/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 173 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 u1: mEq/L rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 30 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 173 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 u1: mEq/L rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 rs: Final st: NotStopd t0: [16:00:00 18/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd
t0: [17:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [17:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 182 u1: mmHg v2: 90 u2: mmHg st: NotStopd t0: [17:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [17:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [18:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 18/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [18:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [18:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [18:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [18:00:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Hi Flow Neb st: NotStopd t0: [18:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 15 u1: lpm st: NotStopd t0: [18:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [18:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [18:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [18:00:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [18:00:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [18:00:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [18:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [17:00:00 18/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [17:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [17:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 450 vu: ml t0: [18:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [18:00:00 18/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [18:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml
t0: [17:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [17:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [18:00:00 18/05/2011] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 250 su: ml rt: IV Drip t0: [18:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [18:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 600 vu: ml
t0: [18:00:00 18/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 150 rs: Manual st: NotStopd
t0: [19:00:00 18/05/2011] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd t0: [19:00:00 18/05/2011] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: MICU cg: -1 ai: 516 vo: 0 st: D/C'd
t0: [15:00:00 18/05/2011] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 25 vu: ml st: Stopped t0: [16:00:00 18/05/2011] id: .9% Normal Saline 500.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 100 vu: ml st: Stopped t0: [16:00:00 18/05/2011] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vu: ml t0: [17:00:00 18/05/2011] id: .9% Normal Saline 500.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vu: ml t0: [17:00:00 18/05/2011] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vu: ml t0: [18:00:00 18/05/2011] id: .9% Normal Saline 500.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vu: ml t0: [18:00:00 18/05/2011] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vu: ml
t0: [08:00:00 18/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 18/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 18/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 18/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 18/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 18/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 18/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 18/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 18/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 18/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 18/05/2011] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip
id: Labetolol el: 103 cu: MICU cg: RN io: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions am: 200 du: mgmin rt: IV Drip
t0: [20:00:00 18/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 18/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: -1 st: D/C'd
t0: [20:00:00 18/05/2011] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 3 cu: MICU cg: -1 ai: 189 vo: 0 st: D/C'd
id: .9% Normal Saline el: 1 cu: MICU cg: RN io: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions vo: 200 du: ml rt: Intravenous Push
t0: [19:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [19:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [19:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [19:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [19:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 18/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 18/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 18/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 18/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 18/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 18/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 18/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 18/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 18/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 18/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 18/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 18/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 18/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 18/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 18/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 18/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 18/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 18/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 18/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 18/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 18/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 18/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 18/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 18/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 18/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [20:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 18/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 18/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [20:00:00 18/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 18/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 18/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 18/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 18/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 18/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 18/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 18/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [20:00:00 18/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Edema/Swelling st: NotStopd t0: [20:00:00 18/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 18/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 18/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 18/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 18/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 18/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 18/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [20:00:00 18/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 18/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [20:00:00 18/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 18/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 18/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 18/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 18/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 18/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [20:00:00 18/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 18/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 18/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 18/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 18/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 18/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 18/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [20:00:00 18/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 18/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 18/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.8333 u1: Deg. C st: NotStopd t0: [20:00:00 18/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.1 u1: Deg. F st: NotStopd t0: [20:00:00 18/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [20:00:00 18/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 18/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 18/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 18/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 18/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 18/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 18/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 18/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 18/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 18/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [20:00:00 18/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [19:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [20:00:00 18/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [20:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [20:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 18/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 90 vu: ml t0: [20:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 960 vu: ml
t0: [19:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip t0: [20:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 0.75 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [20:34:00 18/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [20:34:00 18/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:34:00 18/05/2011] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd t0: [20:34:00 18/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14 t0: [20:34:00 18/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:34:00 18/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:34:00 18/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [20:34:00 18/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:34:00 18/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.6 u1: Deg. C st: NotStopd t0: [20:34:00 18/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:34:00 18/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [20:34:00 18/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:34:00 18/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:34:00 18/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13 u1: L/min st: NotStopd t0: [20:34:00 18/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:34:00 18/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:34:00 18/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [20:34:00 18/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [20:34:00 18/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:34:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:34:00 18/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:34:00 18/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [20:34:00 18/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 409 u1: ml/B st: NotStopd t0: [20:34:00 18/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:34:00 18/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [20:34:00 18/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:34:00 18/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [20:34:00 18/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:34:00 18/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:30:00 18/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 60 vu: ml
tf: [20:00:00 19/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 21 dn: 1 m1: Furosemide v1: 40 u1: mg tf: [20:00:00 19/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 21 dn: 1 m1: Neutra-Phos v1: 1 u1: PKT
t0: [21:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 18/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [21:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 18/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 18/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 18/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 18/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 165 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [21:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [21:00:00 18/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [21:00:00 18/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [21:00:00 18/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 18/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Clay v2: Loose st: NotStopd t0: [21:00:00 18/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [21:00:00 18/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 18/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [21:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [21:00:00 18/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml t0: [21:00:00 18/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Medium t0: [21:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml
t0: [21:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
tf: [10:00:00 19/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Captopril v1: 37.5 u1: mg tf: [19:00:00 19/05/2011] pt: Unit Dose rt: IH fr: BID fs: 10, 22 dn: 2 m1: Fluticasone Propionate 110mcg v1: 2 u1: PUFF tf: [19:00:00 19/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metoprolol v1: 125 u1: mg
t0: [22:00:00 18/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [22:00:00 18/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 18/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [22:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [22:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [22:00:00 18/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 18/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 18/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [22:00:00 18/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 18/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 18/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [22:00:00 18/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 18/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [22:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [22:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [22:00:00 18/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [22:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 900 vu: ml
t0: [22:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [23:00:00 18/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 18/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 18/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 18/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 18/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 18/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 18/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [23:00:00 18/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 18/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [23:00:00 18/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [23:00:00 18/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 18/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [23:00:00 18/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 18/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 18/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [23:00:00 18/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [23:00:00 18/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [23:00:00 18/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 550 vu: ml
t0: [23:00:00 18/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [00:00:00 19/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 19/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 19/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 19/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 19/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 19/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 19/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 19/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 19/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 19/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 19/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 19/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 19/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 19/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 19/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 19/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 19/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 19/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 19/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 19/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 19/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 19/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 19/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [00:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 19/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 19/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [00:00:00 19/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 19/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 19/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 19/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 19/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 19/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 19/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 19/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [00:00:00 19/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 19/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 19/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 19/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 19/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 19/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 19/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [00:00:00 19/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 19/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [00:00:00 19/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 19/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 19/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 19/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 19/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 19/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [00:00:00 19/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 19/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 19/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [00:00:00 19/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 19/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [00:00:00 19/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 19/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [00:00:00 19/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 19/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 19/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [00:00:00 19/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [00:00:00 19/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [00:00:00 19/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 19/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 19/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 19/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
t0: [00:00:00 19/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [00:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [00:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [00:00:00 19/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 35 vu: ml t0: [00:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [00:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml
t0: [00:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [00:00:00 19/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [00:00:00 19/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 19/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14 t0: [00:00:00 19/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 19/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [00:00:00 19/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [00:00:00 19/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 19/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.8 u1: Deg. C st: NotStopd t0: [00:00:00 19/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [00:00:00 19/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [00:00:00 19/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [00:00:00 19/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [00:00:00 19/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.4 u1: L/min st: NotStopd t0: [00:00:00 19/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 19/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 19/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [00:00:00 19/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [00:00:00 19/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 19/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 435 u1: ml/B st: NotStopd t0: [00:00:00 19/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 19/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [00:00:00 19/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 19/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [00:00:00 19/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 19/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:45:00 19/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Other st: NotStopd
t0: [00:45:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml st: Stopped
t0: [23:00:00 19/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 930 ap: none
t0: [00:30:00 19/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:30:00 19/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:30:00 19/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:30:00 19/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:30:00 19/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:30:00 19/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:30:00 19/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:30:00 19/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:30:00 19/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [00:30:00 19/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:30:00 19/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [01:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 172 u1: mmHg v2: 94 u2: mmHg st: NotStopd t0: [01:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 126 u1: mmHg st: NotStopd t0: [01:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [01:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [01:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [01:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 280 vu: ml
t0: [01:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [01:00:00 19/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [01:00:00 19/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [01:00:00 19/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 19/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd
t0: [00:10:00 19/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 95 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 125 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.4 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 95 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 125 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.4 rs: Final st: NotStopd t0: [00:10:00 19/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd
t0: [23:00:00 18/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: 1663 cv: 140 ap: none t0: [23:00:00 18/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: 1663 cv: 0 ap: carryForward
t0: [02:00:00 19/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [02:00:00 19/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 19/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [02:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [02:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [02:00:00 19/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 19/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 19/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [02:00:00 19/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 19/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 19/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [02:00:00 19/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [02:00:00 19/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 35 vu: ml t0: [02:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml
t0: [02:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [23:00:00 19/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 780 cv: 780 ap: none t0: [23:00:00 19/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 435 ap: none t0: [23:00:00 19/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 780 cv: 4025 ap: none t0: [23:00:00 19/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 780 cv: 4025 ap: carryForward
t0: [02:00:00 19/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml
t0: [02:30:00 19/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [23:00:00 19/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -665 cv: -665 ap: none t0: [23:00:00 19/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 55 cv: 1390 ap: none t0: [23:00:00 19/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 115 cv: 2755 ap: none t0: [23:00:00 19/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -665 cv: -1270 ap: carryForward t0: [23:00:00 19/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -665 cv: 14232.5 ap: carryForward
tf: [02:00:00 20/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 3 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [02:00:00 20/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 3 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [03:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [03:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [03:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [03:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 19/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd t0: [03:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [03:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [03:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 19/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 19/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 19/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 19/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 19/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 19/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 19/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 19/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 19/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 19/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 19/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 19/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 19/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [04:00:00 19/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 19/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 19/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 19/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 19/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 19/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 19/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 19/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 19/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 19/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 19/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [04:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 19/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 19/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [04:00:00 19/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 19/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 19/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 19/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 19/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 19/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 19/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 19/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [04:00:00 19/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 19/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 19/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 19/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 19/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 19/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 19/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [04:00:00 19/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 19/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [04:00:00 19/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 19/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 19/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 19/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 19/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 19/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [04:00:00 19/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 19/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 19/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [04:00:00 19/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 19/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [04:00:00 19/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 19/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 19/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 19/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 19/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [04:00:00 19/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [04:00:00 19/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [04:00:00 19/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 19/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 19/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 19/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [03:00:00 19/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml t0: [03:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [03:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [03:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 160 vu: ml t0: [04:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml st: Restart t0: [04:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [04:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [04:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml
t0: [03:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip t0: [04:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [05:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 19/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 19/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [05:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 19/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 19/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [05:00:00 19/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 19/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [05:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [05:00:00 19/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [05:00:00 19/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [05:00:00 19/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 19/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [05:00:00 19/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [05:00:00 19/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 19/05/2011] id: Bath el: 1 cu: MICU cg: RN v1: Done
t0: [00:00:00 19/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Small t0: [05:00:00 19/05/2011] tf: [09:00:00 19/05/2011] dt: 240 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [05:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [05:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [05:00:00 19/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Small t0: [05:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 140 vu: ml
t0: [05:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [06:00:00 19/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 142 rs: Manual st: NotStopd
t0: [05:34:00 19/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [05:34:00 19/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 93.9394 u1: units st: NotStopd t0: [05:34:00 19/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [05:34:00 19/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14 t0: [05:34:00 19/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [05:34:00 19/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [05:34:00 19/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [05:34:00 19/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [05:34:00 19/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.3 u1: Deg. C st: NotStopd t0: [05:34:00 19/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [05:34:00 19/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [05:34:00 19/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [05:34:00 19/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.3 u1: L/min st: NotStopd t0: [05:34:00 19/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:34:00 19/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:34:00 19/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [05:34:00 19/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 93.9394 u1: units st: NotStopd t0: [05:34:00 19/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [05:34:00 19/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [05:34:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [05:34:00 19/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [05:34:00 19/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.33 u1: L st: NotStopd t0: [05:34:00 19/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 370 u1: ml/B st: NotStopd t0: [05:34:00 19/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [05:34:00 19/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [05:34:00 19/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [05:34:00 19/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [05:34:00 19/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [05:34:00 19/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [06:00:00 19/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [06:00:00 19/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 19/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [06:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [06:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [06:00:00 19/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 19/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 19/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [06:00:00 19/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 19/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 19/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 19/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [06:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [06:00:00 19/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [06:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [06:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 130 vu: ml
t0: [06:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [05:00:00 19/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: RRT v1: 7.53 rs: Manual st: NotStopd t0: [05:00:00 19/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: RRT v1: 13 rs: Manual st: NotStopd t0: [05:00:00 19/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: RRT v1: 39 rs: Manual st: NotStopd t0: [05:00:00 19/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: RRT v1: 45 u1: mmHg rs: Manual st: NotStopd t0: [05:00:00 19/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: RRT v1: 132 u1: mmHg rs: Manual st: NotStopd t0: [05:00:00 19/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: RRT v1: 7.53 rs: Manual st: NotStopd
t0: [05:10:00 19/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.7 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 94 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 u1: mEq/L rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 135 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 8.7 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 34 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 94 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 32.2 u1: % rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 11 u1: gm/dl rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 u1: mEq/L rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 152 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.74 u1: /mic l rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 135 rs: Final st: NotStopd t0: [05:10:00 19/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.7 rs: Final st: NotStopd t0: [05:21:00 19/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.53 rs: Final st: NotStopd t0: [05:21:00 19/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 13 rs: Final st: NotStopd t0: [05:21:00 19/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 39 rs: Final st: NotStopd t0: [05:21:00 19/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [05:21:00 19/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 132 u1: mmHg rs: Final st: NotStopd t0: [05:21:00 19/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.53 rs: Final st: NotStopd
t0: [07:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [07:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [07:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [07:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [07:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [07:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [07:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [07:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [07:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 50 vu: ml
t0: [07:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
t0: [08:00:00 19/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [08:00:00 19/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 19/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 14 t0: [08:00:00 19/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 19/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [08:00:00 19/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [08:00:00 19/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 19/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 19/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:00:00 19/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [08:00:00 19/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [08:00:00 19/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [08:00:00 19/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.4 u1: L/min st: NotStopd t0: [08:00:00 19/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 19/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 19/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [08:00:00 19/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [08:00:00 19/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [08:00:00 19/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 520 u1: ml/B st: NotStopd t0: [08:00:00 19/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 19/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [08:00:00 19/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 19/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [08:00:00 19/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [08:00:00 19/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
tf: [07:00:00 20/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 8 dn: 1 m1: Potassium Chloride v1: 20 u1: mEq m2: SW v2: 50 u2: ml
t0: [08:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 19/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 31 u1: mmHg st: NotStopd t0: [08:00:00 19/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 19/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 19/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 19/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 19/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 19/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 19/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 19/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 19/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 19/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [08:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 19/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 19/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 19/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 19/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 19/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 19/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [08:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [08:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [08:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 19/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 19/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 19/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [08:00:00 19/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 19/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 19/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 19/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [09:00:00 19/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [09:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 19/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [09:00:00 19/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [09:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 19/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [09:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [09:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 19/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [09:00:00 19/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [09:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [09:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [09:00:00 19/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 19/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [09:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [09:00:00 19/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [09:00:00 19/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [09:00:00 19/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [09:00:00 19/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [09:00:00 19/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 19/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [09:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 19/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 27 u1: mmHg st: NotStopd t0: [10:00:00 19/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [10:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 19/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [10:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 19/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [10:00:00 19/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 19/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [10:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 19/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [10:00:00 19/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 19/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [10:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [10:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 19/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [10:00:00 19/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [10:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [10:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 19/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [10:00:00 19/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 19/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [10:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [10:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [10:00:00 19/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [10:00:00 19/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [10:00:00 19/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 19/05/2011] tf: [18:00:00 19/05/2011] dt: 480 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [08:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [08:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml t0: [09:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [09:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [09:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [09:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml t0: [10:00:00 19/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 150 vu: ml t0: [10:00:00 19/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [10:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [10:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [10:00:00 19/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 60 vu: ml t0: [10:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [10:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 30 vu: ml
t0: [08:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip t0: [09:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip t0: [10:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
tf: [12:00:00 22/05/2011] pt: Unit Dose rt: NG fr: QD fs: 10 dn: 1 m1: Lansoprazole Oral Suspension v1: 30 u1: mg tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Prednisone v1: 40 u1: mg
t0: [11:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 19/05/2011] id: CVP el: 0 cu: MICU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [11:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [11:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [11:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [11:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [11:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [11:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [11:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [11:00:00 19/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [11:00:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [11:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 45 vu: ml
t0: [11:00:00 19/05/2011] id: Labetolol el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mgmin sv: 100 su: ml rt: IV Drip
tf: [14:00:00 19/05/2011] pt: IV Piggyback rt: IV fr: Q8H fs: 11, 19, 3 dn: 3 m1: Acetazolamide Sodium v1: 250 u1: mg m2: D5W v2: 25 u2: ml
t0: [11:01:00 19/05/2011] id: .9% Normal Saline 200.0ml + 200mgmin Labetolol IV Infusions el: 1 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd
t0: [12:00:00 19/05/2011] id: CVP el: 0 cu: MICU cg: -1 st: D/C'd
t0: [12:00:00 19/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [12:00:00 19/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 19/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 19/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 19/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 19/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 19/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 19/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 19/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 19/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 19/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 19/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 94 u1: BPM st: NotStopd t0: [12:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 19/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 19/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 19/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 19/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 19/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 19/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [12:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 164 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [12:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [12:00:00 19/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 19/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 19/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 19/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [12:00:00 19/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 19/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 19/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 19/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 19/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 19/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 19/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 19/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN st: NotStopd t0: [12:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [13:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 168 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [13:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [13:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [13:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml t0: [13:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [13:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml
t0: [12:00:00 19/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 155 rs: Manual st: NotStopd
t0: [13:00:00 19/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [13:00:00 19/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [13:00:00 19/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [13:00:00 19/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [13:00:00 19/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:00:00 19/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [13:00:00 19/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [13:00:00 19/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 566 u1: ml/B st: NotStopd t0: [13:00:00 19/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [13:00:00 19/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [13:10:00 19/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd t0: [13:10:00 19/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 9 rs: Final st: NotStopd t0: [13:10:00 19/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 37 rs: Final st: NotStopd t0: [13:10:00 19/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 57 u1: mmHg rs: Final st: NotStopd t0: [13:10:00 19/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 142 u1: mmHg rs: Final st: NotStopd t0: [13:10:00 19/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.41 rs: Final st: NotStopd
t0: [10:00:00 19/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [10:00:00 19/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Trach Mask st: NotStopd t0: [10:00:00 19/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT v1: 12 u1: lpm st: NotStopd
t0: [09:00:00 19/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Flovent st: NotStopd t0: [16:00:00 19/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [16:00:00 19/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:00:00 19/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [16:00:00 19/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 19/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [16:00:00 19/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [16:00:00 19/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 19/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 19/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:00:00 19/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [16:00:00 19/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [16:00:00 19/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [16:00:00 19/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [16:00:00 19/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Trach Mask st: NotStopd t0: [16:00:00 19/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT v1: 12 u1: lpm st: NotStopd t0: [16:00:00 19/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 19/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 19/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [16:00:00 19/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [16:00:00 19/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [16:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [16:00:00 19/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [16:00:00 19/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:00:00 19/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [16:00:00 19/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:00:00 19/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [16:00:00 19/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:00:00 19/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
tf: [15:00:00 19/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Captopril v1: 50 u1: mg tf: [11:00:00 20/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Captopril v1: 75 u1: mg tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Haloperidol v1: 2 u1: mg tf: [18:00:00 24/05/2011] pt: Unit Dose rt: TP fr: TID fs: 08, 16, 22 dn: 3 m1: Domeboro v1: 1 u1: PKT tf: [18:00:00 24/05/2011] pt: Unit Dose rt: TP fr: TID fs: 08, 16, 22 dn: 3 m1: Miconazole Powder 2% v1: 1 u1: Appl
t0: [13:00:00 19/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 19/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [13:00:00 19/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 19/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [13:00:00 19/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 19/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 19/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [13:00:00 19/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [13:00:00 19/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 19/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [13:00:00 19/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [13:00:00 19/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 19/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [14:00:00 19/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 19/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 19/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [14:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 98 u1: BPM st: NotStopd t0: [14:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 19/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [14:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 169 u1: mmHg v2: 90 u2: mmHg st: NotStopd t0: [14:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 124 u1: mmHg st: NotStopd t0: [14:00:00 19/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 19/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 19/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [14:00:00 19/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 19/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 19/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 19/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 19/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [15:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 169 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [15:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 116 u1: mmHg st: NotStopd t0: [15:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [15:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 19/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [16:00:00 19/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 19/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 19/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [16:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 19/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 19/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 19/05/2011] id: Family Meeting el: 0 cu: MICU cg: RN v1: yes st: NotStopd t0: [16:00:00 19/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 19/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 19/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 19/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Conferenc st: NotStopd t0: [16:00:00 19/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 19/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 19/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 19/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 19/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [16:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 19/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [16:00:00 19/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 19/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [16:00:00 19/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 19/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [16:00:00 19/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 19/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [16:00:00 19/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 19/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 19/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 19/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 19/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 19/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 19/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN st: NotStopd t0: [16:00:00 19/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [16:00:00 19/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [16:00:00 19/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 19/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 19/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 19/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 170 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [16:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [16:00:00 19/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 19/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 19/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [16:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 19/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 19/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 19/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [16:00:00 19/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 19/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 19/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 19/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 19/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [16:00:00 19/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 19/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm st: NotStopd t0: [16:00:00 19/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [16:00:00 19/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 19/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [16:00:00 19/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [16:00:00 19/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 19/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 19/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: No Apparent Prob st: NotStopd t0: [16:00:00 19/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 19/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [16:00:00 19/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [16:00:00 19/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [16:00:00 19/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [13:00:00 19/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 60 vu: ml t0: [13:00:00 19/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Small t0: [16:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 180 vu: ml t0: [16:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 15 vu: ml t0: [16:00:00 19/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 60 vu: ml t0: [16:00:00 19/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Small t0: [16:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml
tf: [18:00:00 24/05/2011] pt: Unit Dose rt: IV fr: Q6H:PRN m1: Ondansetron v1: 2 u1: mg
t0: [16:00:00 19/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 19/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 19/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 19/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [16:00:00 19/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [17:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [17:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 170 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [17:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [17:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [17:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [17:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [18:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 179 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [18:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 121 u1: mmHg st: NotStopd t0: [18:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [18:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml st: Stopped t0: [18:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 19/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 60 vu: ml
tf: [14:00:00 21/05/2011] pt: IV Piggyback rt: IV fr: Q8H fs: 0, 8, 16 dn: 3 m1: Acetazolamide Sodium v1: 250 u1: mg m2: D5W v2: 25 u2: ml
t0: [19:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [19:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [19:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [19:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [19:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
tf: [19:00:00 20/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 20 dn: 1 m1: Furosemide v1: 40 u1: mg tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: Q24H fs: 20 dn: 1 m1: Levofloxacin v1: 500 u1: mg
t0: [20:10:00 19/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.51 rs: Final st: NotStopd t0: [20:10:00 19/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 11 rs: Final st: NotStopd t0: [20:10:00 19/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 36 rs: Final st: NotStopd t0: [20:10:00 19/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 44 u1: mmHg rs: Final st: NotStopd t0: [20:10:00 19/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 132 u1: mmHg rs: Final st: NotStopd t0: [20:10:00 19/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.51 rs: Final st: NotStopd
t0: [20:10:00 19/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.05 rs: Final st: NotStopd
t0: [20:00:00 19/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 19/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 19/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 19/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 19/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 19/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 19/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 19/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 19/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 19/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 19/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 19/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 19/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 19/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 19/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 19/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 19/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 19/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 19/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 19/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 19/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 19/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 19/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 19/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 19/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [20:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 19/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 19/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [20:00:00 19/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 19/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [20:00:00 19/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [20:00:00 19/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 19/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 19/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 19/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 19/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 19/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 19/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 19/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 19/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 19/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [20:00:00 19/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [20:00:00 19/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 19/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 19/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 19/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 19/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 19/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 19/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 19/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 19/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [20:00:00 19/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 19/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [20:00:00 19/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 19/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 19/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 19/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 19/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Exp Wheeze st: NotStopd t0: [20:00:00 19/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 19/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 19/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [20:00:00 19/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 19/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 19/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [20:00:00 19/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 19/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 19/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 19/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 19/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 19/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [20:00:00 19/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [20:00:00 19/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 19/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 19/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [20:00:00 19/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [20:00:00 19/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [20:00:00 19/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 19/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [20:00:00 19/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 19/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 19/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 19/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [20:00:00 19/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 19/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 19/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 19/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 19/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 19/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 19/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [20:00:00 19/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [20:00:00 19/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [20:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml st: Restart t0: [20:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 1250 vu: ml
t0: [20:00:00 19/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 95 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 86 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 134 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 95 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 86 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 rs: Final st: NotStopd t0: [20:00:00 19/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 134 rs: Final st: NotStopd
t0: [21:00:00 19/05/2011] id: D5W 50.0ml IV Infusions el: 1 cu: MICU cg: -1 ai: 1878 vo: 0 st: D/C'd t0: [21:00:00 19/05/2011] id: D5W IV Infusions el: 1 cu: MICU cg: -1 ai: 189 vo: 0 st: D/C'd t0: [21:00:00 19/05/2011] id: .9% Normal Saline 500.0ml IV Infusions el: 1 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd t0: [21:00:00 19/05/2011] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: -1 ai: 189 vo: 0 st: D/C'd
t0: [20:00:00 19/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [20:00:00 19/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 19/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 19/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [20:00:00 19/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 19/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 19/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:00:00 19/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [20:00:00 19/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:00:00 19/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Flovent st: NotStopd t0: [20:00:00 19/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:00:00 19/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [20:00:00 19/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 19/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 19/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [20:00:00 19/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 17 u1: BPM st: NotStopd t0: [20:00:00 19/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 19/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 539 u1: ml/B st: NotStopd t0: [20:00:00 19/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 19/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [21:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [21:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [21:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [21:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [21:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 19/05/2011] tf: [10:15:00 20/05/2011] dt: 795 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [21:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [21:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 90 vu: ml
t0: [21:30:00 19/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml
tf: [21:00:00 20/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 22 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [21:00:00 20/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 22 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metoprolol v1: 100 u1: mg tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metoprolol v1: 50 u1: mg
t0: [22:00:00 19/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [22:00:00 19/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 19/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 19/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [22:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [22:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 164 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [22:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [22:00:00 19/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 19/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 19/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [22:00:00 19/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 19/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 19/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 19/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [22:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [22:00:00 19/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 65 vu: ml t0: [22:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 90 vu: ml
t0: [22:30:00 19/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml
t0: [23:00:00 19/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 23.913 u1: ml/cmH st: NotStopd t0: [23:00:00 19/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [23:00:00 19/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [23:00:00 19/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [23:00:00 19/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [23:00:00 19/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [23:00:00 19/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [23:00:00 19/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [23:00:00 19/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [23:00:00 19/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [23:00:00 19/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [23:00:00 19/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [23:00:00 19/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [23:00:00 19/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [23:00:00 19/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [23:00:00 19/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [23:00:00 19/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [23:00:00 19/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [23:00:00 19/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [23:00:00 19/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [23:00:00 19/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [23:00:00 19/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [23:00:00 19/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 573 u1: ml/B st: NotStopd t0: [23:00:00 19/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [23:00:00 19/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [23:00:00 19/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [23:00:00 19/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [23:00:00 19/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 19/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 19/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 19/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 19/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 19/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 19/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 108 u1: BPM st: NotStopd t0: [23:00:00 19/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 19/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [23:00:00 19/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [23:00:00 19/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 19/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [23:00:00 19/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 19/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [23:00:00 19/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [23:00:00 19/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 780 vu: ml
t0: [00:00:00 20/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 20/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 20/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 20/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 20/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 20/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 20/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 20/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 20/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 20/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 20/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 20/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 20/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 20/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 20/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 20/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 20/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 20/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 20/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 20/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 20/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 20/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [00:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 20/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 20/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [00:00:00 20/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 20/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [00:00:00 20/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [00:00:00 20/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 20/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 20/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 20/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 20/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 20/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 20/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 20/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 20/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 20/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 20/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 20/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 20/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 20/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [00:00:00 20/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 20/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [00:00:00 20/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 20/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 20/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 20/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 20/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 20/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [00:00:00 20/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 20/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 20/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [00:00:00 20/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 20/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [00:00:00 20/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 20/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [00:00:00 20/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 20/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 20/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5556 u1: Deg. C st: NotStopd t0: [00:00:00 20/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.6 u1: Deg. F st: NotStopd t0: [00:00:00 20/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [00:00:00 20/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 20/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 20/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [00:00:00 20/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 122 rs: Manual st: NotStopd t0: [00:00:00 20/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 19/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Small t0: [00:00:00 20/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 125 vu: ml t0: [00:00:00 20/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [00:00:00 20/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [00:00:00 20/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [00:00:00 20/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 25 vu: ml t0: [00:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 400 vu: ml
t0: [23:00:00 19/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [01:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 20/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 20/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [01:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 20/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 20/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [01:00:00 20/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 20/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [01:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [01:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [01:00:00 20/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [01:00:00 20/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [01:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [01:00:00 20/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 20/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [01:00:00 20/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [01:00:00 20/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [01:00:00 20/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 20/05/2011] id: Bath el: 1 cu: MICU cg: RN v1: Done
t0: [01:00:00 20/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [01:00:00 20/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [01:00:00 20/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vu: ml es: Large t0: [01:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml
t0: [23:00:00 20/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 950 ap: carryForward
t0: [02:00:00 20/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [02:00:00 20/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 20/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [02:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [02:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [02:00:00 20/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 20/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 20/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [02:00:00 20/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 20/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 20/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [02:00:00 20/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [02:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 20/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 20/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [02:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 210 vu: ml
t0: [02:00:00 20/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml
t0: [23:00:00 20/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 340 ap: none
t0: [03:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [03:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [03:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [03:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [03:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 20/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [03:00:00 20/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml t0: [03:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml
t0: [23:00:00 20/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 60 cv: 60 ap: none t0: [23:00:00 20/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -30.8732 cv: -30.8732 ap: none t0: [23:00:00 20/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 29.1268 cv: 887.741 ap: none t0: [23:00:00 20/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 29.1268 cv: 1767.74 ap: none t0: [23:00:00 20/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 540 ap: none t0: [23:00:00 20/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 60 cv: 3950 ap: none t0: [23:00:00 20/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -30.8732 cv: -3132.26 ap: carryForward t0: [23:00:00 20/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 60 cv: 4900 ap: carryForward t0: [23:00:00 20/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -30.8732 cv: 11100.2 ap: carryForward
t0: [04:00:00 20/05/2011] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: -1 st: D/C'd t0: [04:00:00 20/05/2011] id: INV#1 WaveformAppear el: 0 cu: MICU cg: -1 st: D/C'd
t0: [04:00:00 20/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 20/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 20/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 20/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 20/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 20/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 20/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 20/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 20/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 20/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 20/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 20/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [04:00:00 20/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 20/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 20/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 20/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 20/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 20/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 20/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 20/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 20/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 20/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [04:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 20/05/2011] id: INV Line#1 D/C Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [04:00:00 20/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 20/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 24 st: NotStopd t0: [04:00:00 20/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [04:00:00 20/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [04:00:00 20/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 20/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 20/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 20/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 20/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 20/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 20/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 20/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 20/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 20/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 20/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 20/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 20/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 20/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [04:00:00 20/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 20/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [04:00:00 20/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 20/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 20/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 20/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 20/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 20/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [04:00:00 20/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 20/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 20/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [04:00:00 20/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 20/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [04:00:00 20/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 20/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 20/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [04:00:00 20/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 20/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 20/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 20/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.9444 u1: Deg. C st: NotStopd t0: [04:00:00 20/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.3 u1: Deg. F st: NotStopd t0: [04:00:00 20/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [04:00:00 20/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 20/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 20/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [04:00:00 20/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [04:00:00 20/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [04:00:00 20/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 5 vu: ml st: Stopped t0: [04:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml
t0: [04:00:00 20/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.53 rs: Final st: NotStopd t0: [04:00:00 20/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 8 rs: Final st: NotStopd t0: [04:00:00 20/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 32 rs: Final st: NotStopd t0: [04:00:00 20/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 37 u1: mmHg rs: Final st: NotStopd t0: [04:00:00 20/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 128 u1: mmHg rs: Final st: NotStopd t0: [04:00:00 20/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.53 rs: Final st: NotStopd t0: [04:00:00 20/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 0.95 rs: Final st: NotStopd
t0: [04:00:00 20/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [04:00:00 20/05/2011] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 34.375 u1: ml/cmH st: NotStopd t0: [04:00:00 20/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 71.0526 u1: units st: NotStopd t0: [04:00:00 20/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 20/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [04:00:00 20/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 20/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:00:00 20/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 20/05/2011] id: AaDO2 el: 0 cu: MICU cg: RRT v1: 120.2 u1: mmHg st: NotStopd t0: [04:00:00 20/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 20/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [04:00:00 20/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [04:00:00 20/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [04:00:00 20/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:00:00 20/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:00:00 20/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.8 u1: L/min st: NotStopd t0: [04:00:00 20/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Trach Mask st: NotStopd t0: [04:00:00 20/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT v1: 12 u1: lpm st: NotStopd t0: [04:00:00 20/05/2011] id: PAO2 el: 0 cu: MICU cg: RRT v1: 248.2 u1: mmHg st: NotStopd t0: [04:00:00 20/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 20/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 20/05/2011] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [04:00:00 20/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [04:00:00 20/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 71.0526 u1: units st: NotStopd t0: [04:00:00 20/05/2011] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [04:00:00 20/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [04:00:00 20/05/2011] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [04:00:00 20/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:00:00 20/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [04:00:00 20/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.38 u1: L st: NotStopd t0: [04:00:00 20/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 20/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 20/05/2011] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 553 u1: ml/B st: NotStopd t0: [04:00:00 20/05/2011] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [04:00:00 20/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 20/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [04:00:00 20/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 20/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [04:00:00 20/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:00:00 20/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 20/05/2011] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:30:00 20/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:30:00 20/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:30:00 20/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:30:00 20/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:30:00 20/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:30:00 20/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:30:00 20/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:30:00 20/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:30:00 20/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [04:30:00 20/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:30:00 20/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [05:00:00 20/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [05:00:00 20/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [05:00:00 20/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [05:00:00 20/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [05:00:00 20/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [05:00:00 20/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [05:00:00 20/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [05:00:00 20/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [05:00:00 20/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [05:00:00 20/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.6 u1: L/min st: NotStopd t0: [05:00:00 20/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 20/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 20/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [05:00:00 20/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [05:00:00 20/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [05:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [05:00:00 20/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 485 u1: ml/B st: NotStopd t0: [05:00:00 20/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [05:00:00 20/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [03:00:00 20/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.5 u1: mg/dl rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 u1: mEq/L rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.2 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 135 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.5 u1: mg/dl rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 32 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 u1: mEq/L rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.2 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 135 rs: Final st: NotStopd
t0: [03:00:00 20/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.1 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 8.1 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Differential-Basos Hematology el: 0 cu: MICU cg: 1663 v1: 0.1 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Differential-Eos Hematology el: 0 cu: MICU cg: 1663 v1: 0.4 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Differential-Lymphs Hematology el: 0 cu: MICU cg: 1663 v1: 5.2 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Differential-Monos Hematology el: 0 cu: MICU cg: 1663 v1: 2.7 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Differential-Polys Hematology el: 0 cu: MICU cg: 1663 v1: 91.7 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 30 u1: % rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10 u1: gm/dl rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 169 rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.46 u1: /mic l rs: Final st: NotStopd t0: [03:00:00 20/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.1 rs: Final st: NotStopd
t0: [05:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [05:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 166 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [05:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [05:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [05:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 20/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [06:00:00 20/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 20/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [06:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [06:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [06:00:00 20/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 20/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 20/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [06:00:00 20/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 20/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 20/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [06:00:00 20/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 20/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 112 rs: Manual st: NotStopd
t0: [06:00:00 20/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 120 vu: ml t0: [06:00:00 20/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml
t0: [07:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [07:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [07:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [07:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [07:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 320 vu: ml t0: [07:00:00 20/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [07:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml
tf: [06:00:00 21/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 7 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq tf: [06:00:00 21/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 7 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq
t0: [08:00:00 20/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 20/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 20/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 20/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 20/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [08:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 173 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [08:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [08:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [08:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 20/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 20/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.9444 u1: Deg. C st: NotStopd t0: [08:00:00 20/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.3 u1: Deg. F st: NotStopd t0: [08:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 20/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 20/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 100 vu: ml t0: [08:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml
id: Nitroglycerine-k el: 100 cu: MICU cg: RN io: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions am: 100 du: mcgkgmin rt: IV Drip
id: D5W el: 1 cu: MICU cg: RN io: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [09:00:00 20/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [09:00:00 20/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Aerosol-Cool st: NotStopd t0: [09:00:00 20/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT v1: 12 u1: lpm st: NotStopd
t0: [09:30:00 20/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [09:30:00 20/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [09:30:00 20/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [09:30:00 20/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [09:30:00 20/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [09:30:00 20/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [09:30:00 20/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [09:30:00 20/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [09:30:00 20/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [09:30:00 20/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [09:30:00 20/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [09:30:00 20/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Flovent st: NotStopd t0: [09:30:00 20/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [09:30:00 20/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14 u1: L/min st: NotStopd t0: [09:30:00 20/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [09:30:00 20/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [09:30:00 20/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [09:30:00 20/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [09:30:00 20/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [09:30:00 20/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 380 u1: ml/B st: NotStopd t0: [09:30:00 20/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [09:30:00 20/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [09:30:00 20/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [09:30:00 20/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [09:30:00 20/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [09:30:00 20/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
tf: [05:00:00 21/05/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Amlodipine v1: 5 u1: mg tf: [09:00:00 21/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 10 dn: 1 m1: Metoprolol v1: 5 u1: mg tf: [18:00:00 24/05/2011] pt: Unit Dose rt: SL fr: ASDIR m1: Nitroglycerin SL v1: 0.3 u1: mg
t0: [08:30:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:30:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:30:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:30:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:30:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:30:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:30:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [08:30:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:30:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [08:30:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [08:30:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:30:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [08:30:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:30:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 97 u1: BPM st: NotStopd t0: [09:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 178 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [09:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 123 u1: mmHg st: NotStopd t0: [09:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [09:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:30:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:30:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [09:30:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:30:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 206 u1: mmHg v2: 106 u2: mmHg st: NotStopd t0: [09:30:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 145 u1: mmHg st: NotStopd t0: [09:30:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:30:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [09:30:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 20/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:15:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:15:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:15:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:15:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:15:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:15:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:15:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [10:15:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:15:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 169 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [10:15:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [10:15:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:15:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [10:15:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:15:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:15:00 20/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [10:15:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml
t0: [10:35:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:35:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:35:00 20/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:35:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:35:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:35:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:35:00 20/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [10:35:00 20/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:35:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:35:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [10:35:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:35:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 171 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [10:35:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [10:35:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:35:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [10:35:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:35:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:15:00 20/05/2011] tf: [08:00:00 23/05/2011] dt: 4185 id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.345066 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:35:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0.690131 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [10:35:00 20/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.48 rs: Final st: NotStopd t0: [10:35:00 20/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 8 rs: Final st: NotStopd t0: [10:35:00 20/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 34 rs: Final st: NotStopd t0: [10:35:00 20/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 44 u1: mmHg rs: Final st: NotStopd t0: [10:35:00 20/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 105 u1: mmHg rs: Final st: NotStopd t0: [10:35:00 20/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.48 rs: Final st: NotStopd
t0: [11:00:00 20/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd
tf: [10:00:00 21/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Calcium Gluconate v1: 2 u1: gm tf: [10:00:00 21/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Ondansetron v1: 4 u1: mg tf: [20:00:00 22/05/2011] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Nitroglycerin v1: 100 u1: mg m2: D5W v2: 250 u2: ml tf: [18:00:00 24/05/2011] pt: Unit Dose rt: IV fr: Q4H:PRN m1: Morphine Sulfate v1: 1-2 u1: mg
t0: [11:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [11:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 20/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 177 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [11:00:00 20/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 111.667 u1: mmHg st: NotStopd t0: [11:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 176 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [11:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [11:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [11:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:30:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:30:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:30:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [11:30:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:30:00 20/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [11:30:00 20/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [11:30:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 175 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [11:30:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 109 u1: mmHg st: NotStopd t0: [11:30:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:30:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [11:30:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [11:30:00 20/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.0556 u1: Deg. C st: NotStopd t0: [11:30:00 20/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.5 u1: Deg. F st: NotStopd t0: [11:30:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:30:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [11:30:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml
t0: [10:30:00 20/05/2011] id: Total Bili Chemistry el: 0 cu: MICU cg: 1663 v1: 0.5 rs: Final st: NotStopd t0: [10:30:00 20/05/2011] id: ALT Enzymes el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [10:30:00 20/05/2011] id: AST Enzymes el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [10:30:00 20/05/2011] id: Alk. Phosphate Enzymes el: 0 cu: MICU cg: 1663 v1: 47 rs: Final st: NotStopd t0: [10:30:00 20/05/2011] id: Amylase Enzymes el: 0 cu: MICU cg: 1663 v1: 175 rs: Final st: NotStopd t0: [10:30:00 20/05/2011] id: CPK Enzymes el: 0 cu: MICU cg: 1663 v1: 34 rs: Final st: NotStopd t0: [10:30:00 20/05/2011] id: Total Bili (0-1.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.5 rs: Final st: NotStopd
t0: [11:30:00 20/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [11:30:00 20/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [11:30:00 20/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [11:30:00 20/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [11:30:00 20/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [11:30:00 20/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [11:30:00 20/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [11:30:00 20/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:30:00 20/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [11:30:00 20/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [11:30:00 20/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [11:30:00 20/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.8 u1: L/min st: NotStopd t0: [11:30:00 20/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Aerosol-Cool st: NotStopd t0: [11:30:00 20/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT v1: 12 u1: lpm st: NotStopd t0: [11:30:00 20/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:30:00 20/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:30:00 20/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [11:30:00 20/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [11:30:00 20/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [11:30:00 20/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 477 u1: ml/B st: NotStopd t0: [11:30:00 20/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [11:30:00 20/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [11:30:00 20/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [11:30:00 20/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [11:30:00 20/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [11:30:00 20/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [12:00:00 20/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 104 rs: Manual st: NotStopd
tf: [11:00:00 21/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 12 dn: 1 m1: Potassium Chloride v1: 20 u1: mEq m2: SW v2: 50 u2: ml tf: [11:00:00 21/05/2011] 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 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 55 u1: BPM st: NotStopd t0: [12:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [12:00:00 20/05/2011] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [12:00:00 20/05/2011] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79.3333 u1: mmHg st: NotStopd t0: [12:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [12:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [12:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [12:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [13:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 160 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [13:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [13:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [13:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [13:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml
t0: [12:00:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [13:05:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:05:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:05:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:05:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:05:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:05:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:05:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [13:05:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:05:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 167 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [13:05:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [13:05:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:05:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [13:05:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:05:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:05:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.38026 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [10:00:00 20/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 20/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Chest Pain st: NotStopd t0: [12:00:00 20/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 20/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Chest Pain st: NotStopd t0: [13:30:00 20/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:30:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:30:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:30:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:30:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [13:30:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:30:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 158 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [13:30:00 20/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Chest Pain st: NotStopd t0: [13:30:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [13:30:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:30:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [13:30:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:30:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:30:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.38026 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [10:00:00 20/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 300 vu: ml t0: [10:00:00 20/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 0 vu: ml nb: 1 t0: [12:00:00 20/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 60 vu: ml t0: [14:00:00 20/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vo: 500 vu: ml t0: [14:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 180 vu: ml
tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Captopril v1: 100 u1: mg
t0: [15:00:00 20/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [15:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [15:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 20/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [15:00:00 20/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [15:00:00 20/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Aerosol-Cool st: NotStopd t0: [15:00:00 20/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 12 u1: lpm st: NotStopd t0: [15:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [15:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [15:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [15:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 20/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thin st: NotStopd t0: [15:00:00 20/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [15:00:00 20/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [15:00:00 20/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [15:00:00 20/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [15:00:00 20/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [15:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 20/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 20/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [16:00:00 20/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [16:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 20/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 20/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 20/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 20/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 20/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 20/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 20/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 20/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 20/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [16:00:00 20/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 20/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 20/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 20/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [16:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 20/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [16:00:00 20/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 20/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 20/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 20/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 20/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 20/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [16:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 157 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [16:00:00 20/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [16:00:00 20/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 20/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 20/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 20/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [16:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 20/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 20/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [16:00:00 20/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [16:00:00 20/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [16:00:00 20/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [16:00:00 20/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [16:00:00 20/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 20/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [16:00:00 20/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [16:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 320 vu: ml
t0: [15:00:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.38026 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.38026 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [16:00:00 20/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:00:00 20/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [16:00:00 20/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [16:00:00 20/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [16:00:00 20/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 20/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:00:00 20/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [16:00:00 20/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [16:00:00 20/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [16:00:00 20/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT st: NotStopd t0: [16:00:00 20/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT u1: lpm st: NotStopd t0: [16:00:00 20/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 20/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 20/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [16:00:00 20/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [16:00:00 20/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [16:00:00 20/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [16:00:00 20/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:00:00 20/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd
t0: [17:00:00 20/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [17:00:00 20/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 20/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [17:00:00 20/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [17:00:00 20/05/2011] id: Radiologic Study el: 0 cu: MICU cg: RN v1: CT scan st: NotStopd t0: [17:00:00 20/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [17:00:00 20/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [17:00:00 20/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [17:00:00 20/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [17:15:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:15:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:15:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:15:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:15:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:15:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:15:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [17:15:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:15:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [17:15:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [17:15:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:15:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [17:15:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:15:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:30:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:30:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:30:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:30:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:30:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:30:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:30:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [17:30:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:30:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 159 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [17:30:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [17:30:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:30:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [17:30:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [17:30:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:45:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:45:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:45:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:45:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:45:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:45:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:45:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [17:45:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:45:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [17:45:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [17:45:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:45:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [17:45:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [17:45:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 20/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [18:00:00 20/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [18:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 20/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 20/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [18:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 20/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [18:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 56 u1: BPM st: NotStopd t0: [18:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 20/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [18:00:00 20/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [18:00:00 20/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [18:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [18:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [18:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 20/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [18:00:00 20/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [18:00:00 20/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [18:00:00 20/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [18:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:15:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:15:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:15:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:15:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:15:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:15:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:15:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 55 u1: BPM st: NotStopd t0: [18:15:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:15:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [18:15:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [18:15:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:15:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [18:15:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [18:15:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:30:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:30:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:30:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [18:30:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:30:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [18:30:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [18:30:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:30:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [18:30:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [18:30:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:45:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:45:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:45:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:45:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:45:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:45:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:45:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [18:45:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:45:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 157 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [18:45:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [18:45:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:45:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [18:45:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [18:45:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [19:00:00 20/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [19:00:00 20/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [19:00:00 20/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [19:00:00 20/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [19:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [19:00:00 20/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [19:00:00 20/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [19:00:00 20/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [19:00:00 20/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd
t0: [15:00:00 20/05/2011] tf: [20:45:00 22/05/2011] dt: 3225 id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 13 vu: ml t0: [16:00:00 20/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 12 vu: ml t0: [17:00:00 20/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 12 vu: ml t0: [18:00:00 20/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 12 vu: ml t0: [19:00:00 20/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 12.2603 vu: ml
t0: [17:15:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.38026 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:30:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.38026 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:45:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.38026 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.38026 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:15:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.38026 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:30:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.38026 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:45:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [15:00:00 20/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [15:00:00 20/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [15:00:00 20/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [15:00:00 20/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [15:00:00 20/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [15:00:00 20/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [18:00:00 20/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Family at Bedsid st: NotStopd t0: [18:00:00 20/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 20/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 20/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Fam Talked to RN st: NotStopd t0: [18:00:00 20/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 20/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 20/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [18:00:00 20/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 20/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 20/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [18:00:00 20/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 20/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [18:00:00 20/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 20/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 20/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 20/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [18:00:00 20/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [18:00:00 20/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 20/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 20/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [18:00:00 20/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [18:00:00 20/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [18:00:00 20/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Children st: NotStopd t0: [18:00:00 20/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 20/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 20/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [18:00:00 20/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [18:00:00 20/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: No Apparent Prob st: NotStopd t0: [18:00:00 20/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [18:00:00 20/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [18:00:00 20/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [18:00:00 20/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [18:00:00 20/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [18:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml t0: [19:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml
t0: [16:00:00 20/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [16:00:00 20/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [16:00:00 20/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [16:00:00 20/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [17:00:00 20/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [17:00:00 20/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [17:00:00 20/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [17:00:00 20/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [18:00:00 20/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [18:00:00 20/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [18:00:00 20/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [18:00:00 20/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [19:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [19:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 20/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [19:00:00 20/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [19:00:00 20/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [19:00:00 20/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [19:00:00 20/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [19:00:00 20/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [19:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [19:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [19:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [19:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [18:00:00 20/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 91 rs: Manual st: NotStopd
t0: [19:15:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:15:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:15:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:15:00 20/05/2011] id: Readmit <48 hrs el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:15:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:15:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [19:15:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 165 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [19:15:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [19:15:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:15:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [19:15:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [19:15:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [19:30:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:30:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:30:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:30:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:30:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:30:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [19:30:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:30:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [19:30:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [19:30:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:30:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [19:30:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [19:30:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:15:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 1.75 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:30:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [18:00:00 20/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vo: 450 vu: ml
t0: [19:00:00 20/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.9 u1: mg/dl rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 91 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.4 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 132 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.9 u1: mg/dl rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 29 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 91 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.4 rs: Final st: NotStopd t0: [19:00:00 20/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 132 rs: Final st: NotStopd
t0: [20:00:00 20/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 20/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 20/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 20/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 20/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 20/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 20/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 20/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 20/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 20/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 20/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [20:00:00 20/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 20/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 20/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 20/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 20/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 20/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 20/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 20/05/2011] id: GI Guaiac/ph el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [20:00:00 20/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 20/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 20/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [20:00:00 20/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 20/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 20/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [20:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 20/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [20:00:00 20/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [20:00:00 20/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 20/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [20:00:00 20/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [20:00:00 20/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 20/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 20/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 20/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 20/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 20/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 20/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 20/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [20:00:00 20/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [20:00:00 20/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 20/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 20/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 20/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 20/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 20/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 20/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [20:00:00 20/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 20/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [20:00:00 20/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 20/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 20/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 20/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 20/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 20/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [20:00:00 20/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 20/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [20:00:00 20/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 20/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 20/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 20/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [20:00:00 20/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [20:00:00 20/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 20/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 20/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 20/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [20:00:00 20/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [20:00:00 20/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 20/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 20/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 20/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 20/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 20/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 20/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 20/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 20/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 20/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [20:00:00 20/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [20:00:00 20/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [20:00:00 20/05/2011] tf: [18:00:00 21/05/2011] dt: 1320 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 0 vu: ml nb: 1 t0: [20:00:00 20/05/2011] tf: [04:00:00 22/05/2011] dt: 1920 id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 20/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 19.1 vu: ml t0: [20:00:00 20/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [20:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 180 vu: ml
t0: [20:00:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [20:00:00 20/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [20:00:00 20/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [20:00:00 20/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd
t0: [20:00:00 20/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [20:00:00 20/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 20/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [20:00:00 20/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 20/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 20/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:00:00 20/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 20/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 20/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:00:00 20/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 20/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:00:00 20/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:00:00 20/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.65 u1: L/min st: NotStopd t0: [20:00:00 20/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 20/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 20/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [20:00:00 20/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [20:00:00 20/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 20/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 445 u1: ml/B st: NotStopd t0: [20:00:00 20/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 20/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [20:00:00 20/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 20/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [20:00:00 20/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 20/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [19:00:00 20/05/2011] id: CPK/MB Enzymes el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd
tf: [21:00:00 21/05/2011] pt: Unit Dose rt: PO fr: ASDIR m1: Potassium Chloride v1: 40 u1: mEq
t0: [21:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 20/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 54 u1: BPM st: NotStopd t0: [21:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [21:00:00 20/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 20/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 20/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 20/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [21:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [21:00:00 20/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [21:00:00 20/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [21:00:00 20/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [21:00:00 20/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [21:00:00 20/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 20/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 20/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 250 vu: ml t0: [21:00:00 20/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 19.1268 vu: ml t0: [21:00:00 20/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [21:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 70 vu: ml
t0: [21:00:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [21:00:00 20/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 60 vu: ml
t0: [22:00:00 20/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [22:00:00 20/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 20/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [22:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [22:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [22:00:00 20/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 20/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 20/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [22:00:00 20/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 20/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 20/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [22:00:00 20/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 20/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 19.1268 vu: ml t0: [22:00:00 20/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 20/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 35 vu: ml t0: [22:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 150 vu: ml
t0: [22:00:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 20/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 20/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 20/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 20/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 20/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 20/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 20/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 55 u1: BPM st: NotStopd t0: [23:00:00 20/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 20/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [23:00:00 20/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [23:00:00 20/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 20/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [23:00:00 20/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 20/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 20/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 19.1268 vu: ml t0: [23:00:00 20/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [23:00:00 20/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml
t0: [23:00:00 20/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [00:00:00 21/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 21/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 21/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 21/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 21/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 21/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 21/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 21/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 21/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 21/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 21/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [00:00:00 21/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 21/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 21/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 21/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 21/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 21/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 21/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 21/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 21/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 21/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 21/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 56 u1: BPM st: NotStopd t0: [00:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [00:00:00 21/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [00:00:00 21/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [00:00:00 21/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 21/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [00:00:00 21/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [00:00:00 21/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 21/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 21/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 21/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 21/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 21/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 21/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 21/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [00:00:00 21/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [00:00:00 21/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 21/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [00:00:00 21/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [00:00:00 21/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 21/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 21/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 21/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 21/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 21/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 21/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [00:00:00 21/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 21/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [00:00:00 21/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 21/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 21/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 21/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 21/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 21/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [00:00:00 21/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 21/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 21/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [00:00:00 21/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 21/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [00:00:00 21/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 21/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 21/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 21/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 21/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 21/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 21/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [00:00:00 21/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [00:00:00 21/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 21/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 21/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 21/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 21/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [00:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 19.1268 vu: ml t0: [00:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [00:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 140 vu: ml
t0: [00:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [00:00:00 21/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 125 vu: ml
t0: [00:00:00 21/05/2011] id: QTc el: 0 cu: MICU cg: RN v1: 0.39 u1: sec st: NotStopd t0: [00:00:00 21/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 81 rs: Manual st: NotStopd
t0: [00:30:00 21/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [00:30:00 21/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:30:00 21/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:30:00 21/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:30:00 21/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:30:00 21/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:30:00 21/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:30:00 21/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:30:00 21/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:30:00 21/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [00:00:00 21/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml
t0: [23:00:00 21/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 295 ap: none
t0: [01:00:00 21/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [01:00:00 21/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [01:00:00 21/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [01:00:00 21/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [01:00:00 21/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [01:00:00 21/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [01:00:00 21/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [01:00:00 21/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [01:00:00 21/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [01:00:00 21/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [01:00:00 21/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [01:00:00 21/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [01:00:00 21/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.9 u1: L/min st: NotStopd t0: [01:00:00 21/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 21/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 21/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [01:00:00 21/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [01:00:00 21/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [01:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [01:00:00 21/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 455 u1: ml/B st: NotStopd t0: [01:00:00 21/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [01:00:00 21/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [01:00:00 21/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [01:00:00 21/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [01:00:00 21/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [01:00:00 21/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:55:00 21/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.47 rs: Final st: NotStopd t0: [00:55:00 21/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: no data rs: Final st: NotStopd t0: [00:55:00 21/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: no data rs: Final st: NotStopd t0: [00:55:00 21/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 u1: mmHg rs: Final st: NotStopd t0: [00:55:00 21/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 u1: mmHg rs: Final st: NotStopd t0: [00:55:00 21/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.47 rs: Final st: NotStopd t0: [00:55:00 21/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.05 rs: Final st: NotStopd
t0: [01:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [01:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [01:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [01:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [01:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [01:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 19.1268 vu: ml t0: [01:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [01:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 130 vu: ml
t0: [01:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
tf: [01:00:00 22/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 2 dn: 1 m1: Calcium Gluconate v1: 2 u1: gm
t0: [02:00:00 21/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [02:00:00 21/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 21/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [02:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [02:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [02:00:00 21/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 21/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 21/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [02:00:00 21/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 21/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 21/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [02:00:00 21/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 21/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [02:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 19.1268 vu: ml t0: [02:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [02:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml
t0: [02:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [03:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 21/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [03:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [03:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 176 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [03:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 117 u1: mmHg st: NotStopd t0: [03:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [03:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 19.1268 vu: ml t0: [03:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml
t0: [03:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 21/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 21/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 21/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 1813.49 ap: none t0: [23:00:00 21/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN cv: 2543.49 ap: none t0: [23:00:00 21/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 5445 ap: none t0: [23:00:00 21/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN cv: -2901.51 ap: none t0: [23:00:00 21/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 5445 ap: none t0: [23:00:00 21/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN cv: 8198.69 ap: carryForward
t0: [04:00:00 21/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 21/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 21/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 21/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 21/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 21/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [04:00:00 21/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 21/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 21/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 21/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [04:00:00 21/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [04:00:00 21/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 21/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 21/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 21/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 21/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 21/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 21/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 21/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 21/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 21/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 21/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [04:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 21/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [04:00:00 21/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [04:00:00 21/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 21/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [04:00:00 21/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [04:00:00 21/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 21/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 21/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 21/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 21/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 21/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 21/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 21/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [04:00:00 21/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [04:00:00 21/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 21/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 21/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 21/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [04:00:00 21/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [04:00:00 21/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 21/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 21/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 21/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 21/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 21/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 21/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 21/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 184 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [04:00:00 21/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 21/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [04:00:00 21/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 21/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 21/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 21/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 21/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 21/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [04:00:00 21/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 21/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 21/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 21/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 21/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [04:00:00 21/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 21/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 21/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [04:00:00 21/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 21/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 21/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 21/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 21/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 21/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2778 u1: Deg. C st: NotStopd t0: [04:00:00 21/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.1 u1: Deg. F st: NotStopd t0: [04:00:00 21/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [04:00:00 21/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 21/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [04:00:00 21/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 21/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 21/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 21/05/2011] id: Bath el: 1 cu: MICU cg: RN v1: Done t0: [04:00:00 21/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Restless st: NotStopd t0: [04:00:00 21/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [04:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 19.1268 vu: ml t0: [04:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [04:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 240 vu: ml
t0: [04:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:35:00 21/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [04:35:00 21/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:35:00 21/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [04:35:00 21/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:35:00 21/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:35:00 21/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [04:35:00 21/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:35:00 21/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:35:00 21/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [04:35:00 21/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [04:35:00 21/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:35:00 21/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [04:35:00 21/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [04:35:00 21/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:35:00 21/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:35:00 21/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 12 u1: . st: NotStopd t0: [04:35:00 21/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [04:35:00 21/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:35:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:35:00 21/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 465 u1: ml/B st: NotStopd t0: [04:35:00 21/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:35:00 21/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [04:35:00 21/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:35:00 21/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [04:35:00 21/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:35:00 21/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [05:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 53 u1: BPM st: NotStopd t0: [05:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [05:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [05:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [05:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [05:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 26.082 vu: ml t0: [05:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml
t0: [05:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [06:00:00 21/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 68 rs: Manual st: NotStopd
t0: [04:40:00 21/05/2011] id: PT el: 0 cu: MICU cg: 1663 v1: 12.8 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 32.2 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 12.8 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 32.2 rs: Final st: NotStopd
t0: [04:40:00 21/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 5.9 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 5.9 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 26.1 u1: % rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 8.7 u1: gm/dl rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 159 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.97 u1: /mic l rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 5.9 rs: Final st: NotStopd
t0: [06:00:00 21/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 66.8693 u1: units st: NotStopd t0: [06:00:00 21/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 66.8693 u1: units st: NotStopd t0: [06:00:00 21/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [06:00:00 21/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.329 u1: L st: NotStopd
t0: [06:00:00 21/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [06:00:00 21/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [06:00:00 21/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [06:00:00 21/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 378 u1: ml/B st: NotStopd
tf: [05:00:00 22/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 6 dn: 1 m1: Amlodipine v1: 5 u1: mg
t0: [06:00:00 21/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [06:00:00 21/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 21/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [06:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 176 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [06:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [06:00:00 21/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 21/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 21/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [06:00:00 21/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 21/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 21/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [06:00:00 21/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 21/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [06:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 26.082 vu: ml t0: [06:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [06:00:00 21/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 25 vu: ml t0: [06:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml
t0: [06:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:40:00 21/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.5 u1: mg/dl rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 78 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 u1: mEq/L rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 131 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Amylase Enzymes el: 0 cu: MICU cg: 1663 v1: 171 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: CPK Enzymes el: 0 cu: MICU cg: 1663 v1: 41 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.5 u1: mg/dl rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 78 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 u1: mEq/L rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 131 rs: Final st: NotStopd
t0: [04:40:00 21/05/2011] id: Differential-Bands Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Differential-Basos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Differential-Eos Hematology el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Differential-Lymphs Hematology el: 0 cu: MICU cg: 1663 v1: 7.5 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Differential-Monos Hematology el: 0 cu: MICU cg: 1663 v1: 3 rs: Final st: NotStopd t0: [04:40:00 21/05/2011] id: Differential-Polys Hematology el: 0 cu: MICU cg: 1663 v1: 88.6 rs: Final st: NotStopd
t0: [07:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [07:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 174 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [07:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [07:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [07:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 30.429 vu: ml t0: [07:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [07:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 35 vu: ml
t0: [07:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [08:00:00 21/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [08:00:00 21/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 21/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [08:00:00 21/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 21/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:00:00 21/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [08:00:00 21/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 21/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 21/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [08:00:00 21/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 21/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [08:00:00 21/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Flovent st: NotStopd t0: [08:00:00 21/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [08:00:00 21/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.7 u1: L/min st: NotStopd t0: [08:00:00 21/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 21/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 21/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [08:00:00 21/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [08:00:00 21/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [08:00:00 21/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [08:00:00 21/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 21/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 480 u1: ml/B st: NotStopd t0: [08:00:00 21/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 21/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [08:00:00 21/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 21/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [08:00:00 21/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [08:00:00 21/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 21/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 21/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 21/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 21/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 21/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 21/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 21/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [08:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 21/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 21/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 21/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [08:00:00 21/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 21/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 21/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 21/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 21/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 21/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [08:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 21/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [08:00:00 21/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [08:00:00 21/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 21/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [08:00:00 21/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [08:00:00 21/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 21/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 21/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 21/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 21/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 21/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [08:00:00 21/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [08:00:00 21/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 21/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [08:00:00 21/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [08:00:00 21/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 21/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 21/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 21/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 21/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 21/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 21/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 178 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [08:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [08:00:00 21/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 21/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 21/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 21/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 21/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 21/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [08:00:00 21/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 21/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 21/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 21/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 21/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 21/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 21/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 21/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [08:00:00 21/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 21/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 21/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 21/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [08:00:00 21/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [08:00:00 21/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [08:00:00 21/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 21/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 21/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 21/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [08:00:00 21/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [08:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 34.776 vu: ml t0: [08:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 21/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [08:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 600 vu: ml
t0: [08:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [08:00:00 21/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: EKG st: NotStopd
t0: [09:30:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:30:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [09:30:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:30:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 174 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [09:30:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [09:30:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:30:00 21/05/2011] id: Procedures el: 0 cu: MICU cg: RN v1: Blood Cultured st: NotStopd t0: [09:30:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [09:30:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [09:30:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:30:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [09:28:00 21/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.38 rs: Final st: NotStopd t0: [09:28:00 21/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.4 rs: Final st: NotStopd t0: [09:28:00 21/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [09:28:00 21/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 30 rs: Final st: NotStopd t0: [09:28:00 21/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 49 u1: mmHg rs: Final st: NotStopd t0: [09:28:00 21/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 100 u1: mmHg rs: Final st: NotStopd t0: [09:28:00 21/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.38 rs: Final st: NotStopd t0: [09:28:00 21/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.16 rs: Final st: NotStopd t0: [09:28:00 21/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.4 rs: Final st: NotStopd
tf: [12:00:00 22/05/2011] pt: Unit Dose rt: TD fr: QSAT fs: 10 m1: Clonidine TTS 1 Patch v1: 1 u1: PTCH
t0: [10:30:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:30:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:30:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:30:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:30:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [10:30:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:30:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 172 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [10:30:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [10:30:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:30:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [10:30:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [10:30:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:30:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 86.94 vu: ml t0: [10:30:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 25 vu: ml t0: [10:30:00 21/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml
t0: [10:30:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [11:00:00 21/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [11:00:00 21/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [11:00:00 21/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [11:00:00 21/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [11:00:00 21/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [11:00:00 21/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [11:00:00 21/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [11:00:00 21/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 21/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [11:00:00 21/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [11:00:00 21/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [11:00:00 21/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [11:00:00 21/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.7 u1: L/min st: NotStopd t0: [11:00:00 21/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 21/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 21/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [11:00:00 21/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [11:00:00 21/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [11:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 95 u1: % st: NotStopd t0: [11:00:00 21/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [11:00:00 21/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [11:00:00 21/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [11:00:00 21/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [11:00:00 21/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [11:00:00 21/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [11:00:00 21/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [12:00:00 21/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 104 rs: Manual st: NotStopd
t0: [11:30:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: CoWkr ai: 112 vo: 34.776 vu: ml t0: [11:30:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: CoWkr ai: 189 vo: 10 vu: ml t0: [11:30:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: CoWkr vo: 1100 vu: ml
t0: [12:11:00 21/05/2011] id: Blood Products Hematology el: 0 cu: MICU cg: 1663 v1: Y rs: Final st: NotStopd
t0: [11:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 99 u1: BPM st: NotStopd t0: [11:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 167 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [11:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [11:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [11:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [13:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 167 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [13:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [13:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [13:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [13:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 52.164 vu: ml t0: [13:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 15 vu: ml t0: [13:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml
t0: [13:24:00 21/05/2011] id: Blood Products Hematology el: 0 cu: MICU cg: 1663 v1: Y rs: Final st: NotStopd
t0: [13:00:00 21/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [13:00:00 21/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [13:00:00 21/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [14:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [14:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 179 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [14:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [14:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [14:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 34.776 vu: ml t0: [14:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [14:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 500 vu: ml
t0: [14:00:00 21/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [14:00:00 21/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [14:00:00 21/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [14:00:00 21/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [14:00:00 21/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [14:00:00 21/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [14:00:00 21/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [14:00:00 21/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 21/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 50 vu: ml t0: [15:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 34.776 vu: ml t0: [15:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [15:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 260 vu: ml
t0: [16:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [16:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 165 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [16:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [16:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [16:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 21/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 21/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [16:00:00 21/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [16:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 21/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml nb: 1 t0: [16:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 34.776 vu: ml t0: [16:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [16:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml
t0: [16:00:00 21/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 21/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 21/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 21/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 21/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 21/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 21/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 21/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [16:00:00 21/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 21/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 21/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 21/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Bilious st: NotStopd t0: [16:00:00 21/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 21/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 21/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 21/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 21/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [16:00:00 21/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 21/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 21/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 21/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 21/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [16:00:00 21/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 21/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 21/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 21/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 21/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 21/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 21/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 21/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 21/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [16:00:00 21/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 21/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 21/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 21/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 21/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Clonidine HCl v1: 0.1 u1: mg
t0: [16:00:00 21/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [16:00:00 21/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:00:00 21/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 19 t0: [16:00:00 21/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 21/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [16:00:00 21/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [16:00:00 21/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 21/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 21/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [16:00:00 21/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:00:00 21/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [16:00:00 21/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [16:00:00 21/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.3 u1: L/min st: NotStopd t0: [16:00:00 21/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 21/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 21/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [16:00:00 21/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [16:00:00 21/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [16:00:00 21/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 400 u1: ml/B st: NotStopd t0: [16:00:00 21/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:00:00 21/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [16:00:00 21/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:00:00 21/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [16:00:00 21/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:00:00 21/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [16:00:00 21/05/2011] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: 109 vo: 0 vu: ml nb: 1
t0: [17:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [17:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [17:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [17:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [17:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [17:00:00 21/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [17:00:00 21/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [17:00:00 21/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [17:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 21/05/2011] tf: [12:00:00 22/05/2011] dt: 1140 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 34.776 vu: ml t0: [17:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [17:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 260 vu: ml
t0: [09:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [17:00:00 21/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml
t0: [16:45:00 21/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 73 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 u1: mEq/L rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 131 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 26 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 73 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 u1: mEq/L rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 131 rs: Final st: NotStopd
t0: [16:45:00 21/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.7 rs: Final st: NotStopd t0: [16:45:00 21/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.7 rs: Final st: NotStopd
t0: [18:00:00 21/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 80 rs: Manual st: NotStopd
t0: [18:00:00 21/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml t0: [18:00:00 21/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 36.5 vu: ml t0: [18:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 0 vu: ml nb: 1
tf: [18:00:00 24/05/2011] pt: IV Piggyback rt: IV fr: ASDIR m1: Potassium Chloride v1: 20 u1: mEq m2: SW v2: 50 u2: ml
tf: [18:00:00 22/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 19 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [19:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [19:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 163 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [19:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [19:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [19:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 21/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml t0: [19:00:00 21/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [19:00:00 21/05/2011] tf: [12:00:00 22/05/2011] dt: 1020 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 36.5 vu: ml t0: [19:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [19:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 380 vu: ml
t0: [19:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [20:00:00 21/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 21/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 21/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 21/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 21/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 21/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 21/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 21/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 21/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 21/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 21/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 21/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 21/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 21/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 21/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 21/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 21/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 21/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 21/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 21/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 21/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [20:00:00 21/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 21/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 21/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [20:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 21/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [20:00:00 21/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [20:00:00 21/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 21/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [20:00:00 21/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [20:00:00 21/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 21/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 21/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 21/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 21/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 21/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 21/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 21/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [20:00:00 21/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [20:00:00 21/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 21/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [20:00:00 21/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [20:00:00 21/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 21/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 21/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 21/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 21/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 21/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [20:00:00 21/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 160 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [20:00:00 21/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 21/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [20:00:00 21/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 21/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 21/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 21/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 21/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 21/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [20:00:00 21/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 21/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 21/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 21/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 21/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [20:00:00 21/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 21/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 21/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [20:00:00 21/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 21/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 21/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 21/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [20:00:00 21/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [20:00:00 21/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [20:00:00 21/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 21/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 21/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 21/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 21/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 21/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 21/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 21/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 21/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 21/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [20:00:00 21/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [20:00:00 21/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [20:00:00 21/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 21/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 36.5 vu: ml t0: [20:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [20:00:00 21/05/2011] tf: [20:45:00 21/05/2011] dt: 45 id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: 109 vo: 375 vu: ml t0: [20:00:00 21/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 35 vu: ml t0: [20:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 140 vu: ml
t0: [20:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [20:00:00 21/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [20:00:00 21/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 21/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 15 t0: [20:00:00 21/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 21/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 21/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:00:00 21/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 21/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [20:00:00 21/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:00:00 21/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [20:00:00 21/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:00:00 21/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Flovent st: NotStopd t0: [20:00:00 21/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [20:00:00 21/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.8 u1: L/min st: NotStopd t0: [20:00:00 21/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 21/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 21/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [20:00:00 21/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [20:00:00 21/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 21/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 21/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 21/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 420 u1: ml/B st: NotStopd t0: [20:00:00 21/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 21/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [20:00:00 21/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 21/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [20:00:00 21/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 21/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:45:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [20:45:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [20:45:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [20:45:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [20:45:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:45:00 21/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:45:00 21/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [20:45:00 21/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [20:45:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:45:00 21/05/2011] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: 109 vo: 0 vu: ml nb: 1
t0: [23:00:00 21/05/2011] dt: 24 id: Blood Products Total el: 2 cu: MICU cg: RN cv: 375 ap: none
t0: [21:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 21/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [21:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 21/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 21/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 21/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 21/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [21:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [21:00:00 21/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 21/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [21:00:00 21/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 21/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [21:00:00 21/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 21/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 21/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 36.5 vu: ml t0: [21:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [21:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 260 vu: ml
t0: [21:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [22:00:00 21/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [22:00:00 21/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 21/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [22:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 159 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [22:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [22:00:00 21/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 21/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 21/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [22:00:00 21/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 21/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 21/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [22:00:00 21/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 21/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 21/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 36.5 vu: ml t0: [22:00:00 21/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [22:00:00 21/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml
t0: [22:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 21/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 60 ap: none
t0: [22:00:00 21/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 65 vu: ml
t0: [22:15:00 21/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 80 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 132 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 25 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 80 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [22:15:00 21/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 132 rs: Final st: NotStopd
tf: [23:00:00 22/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 0 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml
t0: [23:00:00 21/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 21/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 21/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 21/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 21/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 21/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 21/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [23:00:00 21/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 21/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [23:00:00 21/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [23:00:00 21/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 21/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [23:00:00 21/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 21/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 22/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 22/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 22/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 22/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 22/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 22/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 22/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 22/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 22/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 22/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 22/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 22/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 22/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 22/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 22/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 22/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 22/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 22/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 22/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 22/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 22/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [00:00:00 22/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 22/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 22/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [00:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 22/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [00:00:00 22/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [00:00:00 22/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 22/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [00:00:00 22/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [00:00:00 22/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 22/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 22/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 22/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 22/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 22/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 22/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 22/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [00:00:00 22/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [00:00:00 22/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 22/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [00:00:00 22/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 22/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 22/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 22/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 22/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 22/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 22/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [00:00:00 22/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 22/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [00:00:00 22/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 22/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 22/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 22/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 22/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 22/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [00:00:00 22/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 22/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 22/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [00:00:00 22/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 22/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [00:00:00 22/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 22/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 22/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 22/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 22/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 22/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 22/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.7778 u1: Deg. C st: NotStopd t0: [00:00:00 22/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 100 u1: Deg. F st: NotStopd t0: [00:00:00 22/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [00:00:00 22/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 22/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 22/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 22/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [00:00:00 22/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 40 vu: ml t0: [00:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 73 vu: ml t0: [00:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 150 vu: ml t0: [00:00:00 22/05/2011] tf: [14:07:00 24/05/2011] dt: 3727 id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: 109 vo: 375 vu: ml t0: [00:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 360 vu: ml
t0: [23:00:00 21/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [00:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [00:00:00 22/05/2011] id: QTc el: 0 cu: MICU cg: RN v1: 0.38 u1: sec st: NotStopd t0: [00:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 22/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 95 rs: Manual st: NotStopd
t0: [00:00:00 22/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [00:00:00 22/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml
t0: [01:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [01:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [01:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [01:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [01:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 22/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml t0: [01:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [01:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 36.5 vu: ml t0: [01:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [01:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml
t0: [01:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [01:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [01:00:00 22/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [01:00:00 22/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 15 t0: [01:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [01:00:00 22/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [01:00:00 22/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [01:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [01:00:00 22/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [01:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [01:00:00 22/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [01:00:00 22/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [01:00:00 22/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [01:00:00 22/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [01:00:00 22/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 22/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 22/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [01:00:00 22/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [01:00:00 22/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [01:00:00 22/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 450 u1: ml/B st: NotStopd t0: [01:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [01:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [01:00:00 22/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [01:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [01:00:00 22/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [01:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [01:00:00 22/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [01:00:00 22/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 22/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [01:00:00 22/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 22/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [01:00:00 22/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 22/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [01:00:00 22/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [01:00:00 22/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [03:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [03:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [03:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [03:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [03:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 22/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml t0: [03:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [03:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 36.5 vu: ml t0: [03:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [03:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 280 vu: ml
t0: [03:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:00:00 22/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 22/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 22/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 22/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 22/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 22/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 22/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 22/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 22/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 22/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 22/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 22/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 22/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [04:00:00 22/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 22/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 22/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 22/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 22/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 22/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 22/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 22/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [04:00:00 22/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 22/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [04:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 22/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [04:00:00 22/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [04:00:00 22/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 22/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [04:00:00 22/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [04:00:00 22/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 22/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 22/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 22/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [04:00:00 22/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 22/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 22/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 22/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [04:00:00 22/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [04:00:00 22/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 22/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [04:00:00 22/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [04:00:00 22/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 22/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 22/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 22/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 22/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [04:00:00 22/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [04:00:00 22/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 22/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [04:00:00 22/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 22/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 22/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 22/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 22/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 22/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [04:00:00 22/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 22/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 22/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [04:00:00 22/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 22/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [04:00:00 22/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 22/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 22/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 22/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 22/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 22/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 22/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [04:00:00 22/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [04:00:00 22/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [04:00:00 22/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 22/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 22/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 22/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [04:00:00 22/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [04:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [04:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 36.5 vu: ml t0: [04:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [04:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 240 vu: ml
t0: [04:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:32:00 22/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.43 rs: Final st: NotStopd t0: [04:32:00 22/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [04:32:00 22/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 25 rs: Final st: NotStopd t0: [04:32:00 22/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 37 u1: mmHg rs: Final st: NotStopd t0: [04:32:00 22/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 136 u1: mmHg rs: Final st: NotStopd t0: [04:32:00 22/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.43 rs: Final st: NotStopd t0: [04:32:00 22/05/2011] id: Ionized Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.11 rs: Final st: NotStopd
t0: [04:00:00 22/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml
t0: [05:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 22/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [05:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 22/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 22/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [05:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [05:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 22/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 22/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [05:00:00 22/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 22/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 179 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [05:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 119 u1: mmHg st: NotStopd t0: [05:00:00 22/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [05:00:00 22/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [05:00:00 22/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [05:00:00 22/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [05:00:00 22/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [05:00:00 22/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [05:00:00 22/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [05:00:00 22/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 22/05/2011] id: Bath el: 1 cu: MICU cg: RN v1: Done
t0: [05:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [05:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 36.5 vu: ml t0: [05:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [05:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml
t0: [05:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 4.1983 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:25:00 22/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.6 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 7.6 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 31.4 u1: % rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 11 u1: gm/dl rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 173 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.69 u1: /mic l rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.6 rs: Final st: NotStopd
t0: [05:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [05:00:00 22/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 83.7838 u1: units st: NotStopd t0: [05:00:00 22/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [05:00:00 22/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 15 t0: [05:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [05:00:00 22/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [05:00:00 22/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [05:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [05:00:00 22/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [05:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [05:00:00 22/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [05:00:00 22/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [05:00:00 22/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [05:00:00 22/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.7 u1: L/min st: NotStopd t0: [05:00:00 22/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 22/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 22/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [05:00:00 22/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 83.7838 u1: units st: NotStopd t0: [05:00:00 22/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [05:00:00 22/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [05:00:00 22/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [05:00:00 22/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.37 u1: L st: NotStopd t0: [05:00:00 22/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [05:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [05:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [05:00:00 22/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [05:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [05:00:00 22/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [05:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [06:00:00 22/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 114 rs: Manual st: NotStopd
t0: [06:00:00 22/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 0 u1: cmH2O st: NotStopd t0: [06:00:00 22/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [06:00:00 22/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Support st: NotStopd
t0: [06:00:00 22/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [06:00:00 22/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 22/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [06:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [06:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [06:00:00 22/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 22/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 22/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [06:00:00 22/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 22/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 22/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [06:00:00 22/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [06:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 36.5 vu: ml t0: [06:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [06:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 180 vu: ml
t0: [06:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:25:00 22/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.8 u1: mg/dl rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 100 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 99 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 u1: mEq/L rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 132 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.8 u1: mg/dl rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 25 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 100 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 99 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 u1: mEq/L rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 rs: Final st: NotStopd t0: [04:25:00 22/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 132 rs: Final st: NotStopd
t0: [07:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [07:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [07:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [07:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [07:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [08:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [08:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [08:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [08:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
tf: [07:00:00 23/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 8 dn: 1 m1: Potassium Chloride v1: 20 u1: mEq m2: SW v2: 50 u2: ml tf: [07:00:00 23/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 8 dn: 1 m1: Calcium Gluconate v1: 2 u1: gm tf: [07:00:00 23/05/2011] pt: Unit Dose rt: IV fr: ONCE fs: 8 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [08:00:00 22/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 22/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 22/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 22/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [08:00:00 22/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd
t0: [07:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [07:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [07:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [07:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [07:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [07:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [07:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [07:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [07:30:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [07:30:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [07:30:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [07:30:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [07:30:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:30:00 22/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [07:30:00 22/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [07:30:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [07:30:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [07:30:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [07:30:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [08:00:00 22/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 22/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 22/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [08:00:00 22/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 22/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 22/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 22/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 22/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 22/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 22/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 22/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 22/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 22/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 22/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 22/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 22/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 22/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 22/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 22/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 22/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 22/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 22/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [08:00:00 22/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [08:00:00 22/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 22/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [08:00:00 22/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [08:00:00 22/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 22/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 22/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 22/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 22/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 22/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 22/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 22/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [08:00:00 22/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [08:00:00 22/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 22/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 22/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 22/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [08:00:00 22/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [08:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 22/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [08:00:00 22/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 22/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 22/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 22/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [08:00:00 22/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [08:00:00 22/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 22/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 22/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 22/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 22/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [08:00:00 22/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 22/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 22/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 22/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 22/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 22/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 22/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [08:00:00 22/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 22/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 22/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 22/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 22/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 22/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 22/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [08:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [08:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [08:00:00 22/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 22/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 22/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [08:00:00 22/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 22/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 22/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 22/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 22/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 22/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 22/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 22/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 22/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [08:00:00 22/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [07:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [07:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 30.429 vu: ml t0: [07:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [08:00:00 22/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 150 vu: ml t0: [08:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [08:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 30.429 vu: ml t0: [08:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [08:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 90 vu: ml
t0: [08:00:00 22/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 22/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 15 t0: [08:00:00 22/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [08:00:00 22/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [08:00:00 22/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.6 u1: Deg. C st: NotStopd t0: [08:00:00 22/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [08:00:00 22/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [08:00:00 22/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Flovent st: NotStopd t0: [08:00:00 22/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [08:00:00 22/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.7 u1: L/min st: NotStopd t0: [08:00:00 22/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 22/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 22/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [08:00:00 22/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:00:00 22/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 22/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 514 u1: ml/B st: NotStopd t0: [08:00:00 22/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 22/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd
t0: [09:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [09:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.4 u1: torr st: NotStopd t0: [09:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [09:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [09:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [09:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [09:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [09:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [09:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [09:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [09:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [09:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [09:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [09:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 22/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 200 vu: ml t0: [09:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [09:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 26.082 vu: ml t0: [09:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [09:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml
t0: [09:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [08:30:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:30:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:30:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:30:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:30:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [08:30:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [08:30:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [08:30:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:30:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [08:30:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:30:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:30:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:30:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [09:30:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:30:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [09:30:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [09:30:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:30:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [09:30:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:30:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:30:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:30:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Amlodipine v1: 10 u1: mg tf: [18:00:00 24/05/2011] pt: Unit Dose rt: TD fr: QSUN fs: 10 dn: 0 m1: Clonidine TTS 3 Patch v1: 1 u1: PTCH
t0: [10:00:00 22/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Trach Mask st: NotStopd t0: [10:47:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [10:47:00 22/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Trach Mask st: NotStopd t0: [10:47:00 22/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RRT v1: 12 u1: lpm st: NotStopd
t0: [09:00:00 22/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 22/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 22/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [09:00:00 22/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 22/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 22/05/2011] id: Bath el: 1 cu: MICU cg: RN v1: bath t0: [10:00:00 22/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [10:00:00 22/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [10:00:00 22/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 22/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [10:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 22/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [10:00:00 22/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 22/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 22/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [10:00:00 22/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [10:00:00 22/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [10:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 22/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [10:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 22/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [10:00:00 22/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [10:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 22/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [10:00:00 22/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [10:00:00 22/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [10:00:00 22/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [10:00:00 22/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [10:00:00 22/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [10:00:00 22/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [10:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [10:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [10:00:00 22/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [10:00:00 22/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [10:00:00 22/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [10:00:00 22/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [10:00:00 22/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [10:00:00 22/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [10:00:00 22/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [10:00:00 22/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [10:00:00 22/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [10:00:00 22/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [10:00:00 22/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [10:00:00 22/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [10:00:00 22/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [10:00:00 22/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [10:00:00 22/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [10:00:00 22/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [10:00:00 22/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [10:00:00 22/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [10:00:00 22/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 22/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [10:00:00 22/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [10:00:00 22/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [10:00:00 22/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [10:00:00 22/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [10:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 162 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [10:00:00 22/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [10:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [10:00:00 22/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 22/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 22/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [10:00:00 22/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 22/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 22/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [10:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [10:00:00 22/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 22/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 22/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: RestraintReapply st: NotStopd t0: [10:00:00 22/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 22/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [10:00:00 22/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [10:00:00 22/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [10:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 22/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [10:00:00 22/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [10:00:00 22/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [10:00:00 22/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 22/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [10:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 22/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [10:00:00 22/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [10:00:00 22/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [10:00:00 22/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [10:00:00 22/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [10:00:00 22/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [10:00:00 22/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [10:00:00 22/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [10:00:00 22/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [11:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [11:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [11:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [11:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [11:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [11:00:00 22/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [11:00:00 22/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 12 u1: lpm st: NotStopd t0: [11:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 157 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [11:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [11:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [11:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [11:00:00 22/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [11:00:00 22/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [11:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [11:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [11:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [11:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [11:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [10:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 19.5615 vu: ml t0: [10:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [10:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 340 vu: ml t0: [11:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [11:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 17.388 vu: ml t0: [11:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [11:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 320 vu: ml
t0: [10:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [12:00:00 22/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 127 rs: Manual st: NotStopd
t0: [12:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 22/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [12:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 162 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [12:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [12:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [12:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 22/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 22/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [12:00:00 22/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [12:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml st: Stopped t0: [12:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml st: Stopped t0: [12:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 450 vu: ml
t0: [12:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [11:00:00 22/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [12:00:00 22/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [12:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [12:00:00 22/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 22/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 22/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 22/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 22/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 22/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [12:00:00 22/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [12:00:00 22/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 22/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 22/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 22/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 22/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 22/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 22/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 22/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [12:00:00 22/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [12:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 22/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 22/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 22/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 22/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 22/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [12:00:00 22/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 12 u1: lpm st: NotStopd t0: [12:00:00 22/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 22/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [12:00:00 22/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Bronchial st: NotStopd t0: [12:00:00 22/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 22/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 22/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 22/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 22/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 22/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [12:00:00 22/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 22/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 22/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 22/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [12:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [12:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [12:00:00 22/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 22/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [12:00:00 22/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [12:00:00 22/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 22/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 22/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [12:00:00 22/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [12:00:00 22/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [12:00:00 22/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [12:00:00 22/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [12:00:00 22/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [12:00:00 22/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [12:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 17.388 vu: ml
t0: [12:00:00 22/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [12:00:00 22/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [12:00:00 22/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 22/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [12:00:00 22/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [12:00:00 22/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 22/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 22/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 22/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [12:00:00 22/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 22/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 22/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [12:00:00 22/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [12:00:00 22/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd
tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: QID:PRN m1: Aluminum-Magnesium Hydroxide v1: 15-30 u1: ml
t0: [12:00:00 22/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 22/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 22/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 22/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 22/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [13:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [13:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [13:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [13:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [13:00:00 22/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [13:00:00 22/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 12 u1: lpm st: NotStopd t0: [13:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [13:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [13:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [13:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [13:00:00 22/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [13:00:00 22/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [13:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [13:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [13:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [13:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [13:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 17.388 vu: ml t0: [13:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 280 vu: ml
t0: [13:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:25:00 22/05/2011] id: Amylase Enzymes el: 0 cu: MICU cg: 1663 v1: 169 rs: Final st: NotStopd
t0: [12:00:00 22/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [13:00:00 22/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [14:00:00 22/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Family at Bedsid st: NotStopd t0: [14:00:00 22/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [14:00:00 22/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [14:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [14:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 22/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [14:00:00 22/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 22/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 22/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [14:00:00 22/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [14:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 22/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [14:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 22/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [14:00:00 22/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 22/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [14:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [14:00:00 22/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [14:00:00 22/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 22/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [14:00:00 22/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 22/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [14:00:00 22/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [14:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [14:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 22/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [14:00:00 22/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [14:00:00 22/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 22/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [14:00:00 22/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [14:00:00 22/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 22/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [14:00:00 22/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [14:00:00 22/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [14:00:00 22/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 22/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [14:00:00 22/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 22/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [14:00:00 22/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [14:00:00 22/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 22/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 22/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 22/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [14:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [14:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 22/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 22/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [14:00:00 22/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [14:00:00 22/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 22/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [14:00:00 22/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 12 u1: lpm st: NotStopd t0: [14:00:00 22/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 22/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 22/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [14:00:00 22/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [14:00:00 22/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [14:00:00 22/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [14:00:00 22/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 22/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 22/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 22/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [14:00:00 22/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 22/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [14:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [14:00:00 22/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 22/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 22/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 22/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 22/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [14:00:00 22/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [14:00:00 22/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [14:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 22/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [14:00:00 22/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [14:00:00 22/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [14:00:00 22/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [14:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [14:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [14:00:00 22/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [14:00:00 22/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [14:00:00 22/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [14:00:00 22/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 22/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [14:00:00 22/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [14:00:00 22/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [14:00:00 22/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [14:00:00 22/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [14:00:00 22/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [14:00:00 22/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [14:00:00 22/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [14:00:00 22/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [14:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 17.388 vu: ml t0: [14:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 190 vu: ml
t0: [14:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [14:35:00 22/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.38 rs: Final st: NotStopd t0: [14:35:00 22/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [14:35:00 22/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [14:35:00 22/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [14:35:00 22/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 85 u1: mmHg rs: Final st: NotStopd t0: [14:35:00 22/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.38 rs: Final st: NotStopd
t0: [15:00:00 22/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [15:00:00 22/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd
t0: [15:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [15:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [15:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [15:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [15:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [15:00:00 22/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [15:00:00 22/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 12 u1: lpm st: NotStopd t0: [15:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [15:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [15:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [15:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [15:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [15:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [15:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [15:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 17.388 vu: ml t0: [15:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml
t0: [15:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [14:20:00 22/05/2011] id: Amylase Enzymes el: 0 cu: MICU cg: 1663 v1: 161 rs: Final st: NotStopd
t0: [16:00:00 22/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 22/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [16:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [16:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 22/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 22/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 22/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 22/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [16:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [16:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [16:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 22/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [16:00:00 22/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 12 u1: lpm st: NotStopd t0: [16:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [16:00:00 22/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 22/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [16:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [16:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 22/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 22/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [16:00:00 22/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [16:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [16:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [16:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [16:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [16:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 22/05/2011] tf: [17:00:00 23/05/2011] dt: 1500 id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml st: Restart t0: [16:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 17.388 vu: ml t0: [16:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 220 vu: ml
t0: [16:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [12:00:00 22/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [16:00:00 22/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [16:30:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [16:30:00 22/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [16:30:00 22/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 17 t0: [16:30:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:30:00 22/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [16:30:00 22/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [16:30:00 22/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [16:30:00 22/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [16:30:00 22/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [16:30:00 22/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.9 u1: L/min st: NotStopd t0: [16:30:00 22/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:30:00 22/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:30:00 22/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [16:30:00 22/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [16:30:00 22/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:30:00 22/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [16:30:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:30:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [16:30:00 22/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:30:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [16:30:00 22/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:30:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [14:00:00 22/05/2011] id: QTc el: 0 cu: MICU cg: RN v1: 0.38 u1: sec st: NotStopd t0: [17:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [17:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [17:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [17:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [17:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [16:00:00 22/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 22/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 22/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 22/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 22/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 14 u1: points st: NotStopd t0: [16:00:00 22/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 22/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 22/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [16:00:00 22/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 22/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 22/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [16:00:00 22/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [16:00:00 22/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [16:00:00 22/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [16:00:00 22/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [16:00:00 22/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [16:00:00 22/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 22/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [16:00:00 22/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [16:00:00 22/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 22/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 22/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 22/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [16:00:00 22/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 22/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 22/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 22/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [16:00:00 22/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [16:00:00 22/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 22/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 22/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 22/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [16:00:00 22/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 22/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 22/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 22/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [16:00:00 22/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 22/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 4 Confused st: NotStopd t0: [16:00:00 22/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [17:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [17:00:00 22/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [17:00:00 22/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [17:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [17:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [17:00:00 22/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [17:00:00 22/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 12 u1: lpm st: NotStopd t0: [17:00:00 22/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [17:00:00 22/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 22/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [17:00:00 22/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [17:00:00 22/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [17:00:00 22/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [17:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [17:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [17:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [17:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [17:00:00 22/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [18:00:00 22/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [18:00:00 22/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [18:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [18:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 22/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [18:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 22/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 22/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [18:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 22/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [18:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 22/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [18:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 22/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [18:00:00 22/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [18:00:00 22/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [18:00:00 22/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 22/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [18:00:00 22/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [18:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 22/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [18:00:00 22/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [18:00:00 22/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [18:00:00 22/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [18:00:00 22/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [18:00:00 22/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [18:00:00 22/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [18:00:00 22/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [18:00:00 22/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [18:00:00 22/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 22/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [18:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 22/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 22/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [18:00:00 22/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [18:00:00 22/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [18:00:00 22/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [18:00:00 22/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 12 u1: lpm st: NotStopd t0: [18:00:00 22/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [18:00:00 22/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [18:00:00 22/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [18:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [18:00:00 22/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [18:00:00 22/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [18:00:00 22/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 22/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 22/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [18:00:00 22/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [18:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [18:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 22/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [18:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [18:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [18:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [18:00:00 22/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 22/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [18:00:00 22/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [18:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [18:00:00 22/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [18:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 22/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [17:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [17:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 17.388 vu: ml t0: [17:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml t0: [18:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [18:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 17.388 vu: ml t0: [18:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml
t0: [18:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [18:00:00 22/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [18:00:00 22/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [18:00:00 22/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 124 rs: Manual st: NotStopd t0: [19:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [19:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [19:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [19:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [19:00:00 22/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [19:00:00 22/05/2011] id: O2 Flow (lpm) el: 0 cu: MICU cg: RN v1: 12 u1: lpm st: NotStopd t0: [19:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [19:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [19:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [19:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [19:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [19:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [19:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [19:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 22/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [19:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [19:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 17.388 vu: ml t0: [19:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml
t0: [19:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [20:00:00 22/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 22/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 22/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 22/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 22/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 22/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 22/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 22/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 22/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 22/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 22/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [20:00:00 22/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [20:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 22/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [20:00:00 22/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [20:00:00 22/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 22/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [20:00:00 22/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [20:00:00 22/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 22/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 22/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 22/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 22/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 22/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [20:00:00 22/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [20:00:00 22/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 22/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [20:00:00 22/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 22/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 22/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 22/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 22/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 22/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [20:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [20:00:00 22/05/2011] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [20:00:00 22/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 22/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 22/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 22/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 22/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 22/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [20:00:00 22/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 22/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 22/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 22/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 22/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 22/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 22/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 22/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 22/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6111 u1: Deg. C st: NotStopd t0: [20:00:00 22/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.7 u1: Deg. F st: NotStopd t0: [20:00:00 22/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Pink v2: Clear st: NotStopd t0: [20:00:00 22/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 22/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 22/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 22/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 22/05/2011] tf: [00:00:00 23/05/2011] dt: 240 id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [20:00:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 17.388 vu: ml t0: [20:00:00 22/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [20:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 80 vu: ml
t0: [20:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [20:00:00 22/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [20:00:00 22/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 22/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 17 t0: [20:00:00 22/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 22/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 22/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [20:00:00 22/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 22/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 22/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:00:00 22/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [20:00:00 22/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:00:00 22/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Flovent st: NotStopd t0: [20:00:00 22/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [20:00:00 22/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.6 u1: L/min st: NotStopd t0: [20:00:00 22/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 22/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 22/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [20:00:00 22/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [20:00:00 22/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 22/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 22/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [20:00:00 22/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 447 u1: ml/B st: NotStopd t0: [20:00:00 22/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 22/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [20:00:00 22/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 22/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [20:00:00 22/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 22/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:45:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:45:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:45:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:45:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:45:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:45:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:45:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [20:45:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:45:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [20:45:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [20:45:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:45:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [20:45:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [20:45:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:45:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 22.5 vu: ml t0: [20:45:00 22/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: RN ai: 112 vo: 13.041 vu: ml st: Stopped
t0: [20:45:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [21:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [21:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [21:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [21:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [21:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
tf: [18:00:00 24/05/2011] pt: Unit Dose rt: NG fr: BID fs: 10, 22 dn: 2 m1: Lansoprazole Oral Suspension v1: 30 u1: mg
t0: [22:00:00 22/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 22/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 22/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 22/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 22/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 22/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 22/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 53 u1: BPM st: NotStopd t0: [22:00:00 22/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 22/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [22:00:00 22/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [22:00:00 22/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 22/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [22:00:00 22/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 22/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 22/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 37.5 vu: ml t0: [22:00:00 22/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 100 vu: ml
t0: [22:00:00 22/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [00:00:00 23/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [00:00:00 23/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 23/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 17 t0: [00:00:00 23/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 23/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [00:00:00 23/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [00:00:00 23/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 23/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [00:00:00 23/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [00:00:00 23/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [00:00:00 23/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [00:00:00 23/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [00:00:00 23/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.5 u1: L/min st: NotStopd t0: [00:00:00 23/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 23/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 23/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [00:00:00 23/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 23 u1: BPM st: NotStopd t0: [00:00:00 23/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [00:00:00 23/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Bloody v2: Thick st: NotStopd t0: [00:00:00 23/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 23/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 498 u1: ml/B st: NotStopd t0: [00:00:00 23/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 23/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [00:00:00 23/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 23/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [00:00:00 23/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 23/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 22/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [00:00:00 23/05/2011] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 23/05/2011] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 23/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 23/05/2011] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 23/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 23/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 23/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 23/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 23/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 23/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 23/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 23/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 23/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 23/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [00:00:00 23/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [00:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 23/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [00:00:00 23/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [00:00:00 23/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 23/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [00:00:00 23/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [00:00:00 23/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 23/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 23/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [00:00:00 23/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 23/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 23/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [00:00:00 23/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [00:00:00 23/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 23/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [00:00:00 23/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 23/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 23/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 23/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 23/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Loose Teeth st: NotStopd t0: [00:00:00 23/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [00:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [00:00:00 23/05/2011] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 23/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 23/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 23/05/2011] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 23/05/2011] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 23/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [00:00:00 23/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 23/05/2011] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 23/05/2011] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 23/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 23/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 23/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 23/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 23/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [00:00:00 23/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [00:00:00 23/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Pink v2: Clear st: NotStopd t0: [00:00:00 23/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 23/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 23/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 23/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 107 rs: Manual st: NotStopd t0: [00:00:00 23/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 23/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [00:00:00 23/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 23/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 23/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [00:00:00 23/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 23/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [00:00:00 23/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [00:00:00 23/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [00:00:00 23/05/2011] id: TF Residual Gastric/TF Residual el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml t0: [00:00:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [00:00:00 23/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 50 vu: ml t0: [00:00:00 23/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vo: 400 vu: ml t0: [00:00:00 23/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 160 vu: ml
t0: [00:00:00 23/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 23/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 30 cv: 525 ap: none t0: [23:00:00 23/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 440 ap: none t0: [23:00:00 23/05/2011] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 780 ap: none
t0: [02:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 47 u1: BPM st: NotStopd t0: [02:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [02:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [02:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [02:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [02:00:00 23/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 200 vu: ml
t0: [02:00:00 23/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [03:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [03:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [03:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [03:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [03:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 23/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:13:00 23/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.43 rs: Final st: NotStopd t0: [04:13:00 23/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:13:00 23/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 27 rs: Final st: NotStopd t0: [04:13:00 23/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 39 u1: mmHg rs: Final st: NotStopd t0: [04:13:00 23/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 133 u1: mmHg rs: Final st: NotStopd t0: [04:13:00 23/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.43 rs: Final st: NotStopd
t0: [04:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [04:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 158 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [04:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [04:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [04:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [04:00:00 23/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml
t0: [04:00:00 23/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:00:00 23/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [04:00:00 23/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 6.2 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 23/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 6.2 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 17 t0: [04:00:00 23/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 23/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [04:00:00 23/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [04:00:00 23/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 23/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [04:00:00 23/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [04:00:00 23/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [04:00:00 23/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:00:00 23/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:00:00 23/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.1 u1: L/min st: NotStopd t0: [04:00:00 23/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 23/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 23/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [04:00:00 23/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 23/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:00:00 23/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 495 u1: ml/B st: NotStopd t0: [04:00:00 23/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 23/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [04:00:00 23/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 23/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [04:00:00 23/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:00:00 23/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 23/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 31 u1: % rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 11 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 174 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.64 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 6.2 rs: Final st: NotStopd
t0: [04:00:00 23/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.8 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 104 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.7 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.8 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 104 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.7 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd
t0: [04:00:00 23/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.7 rs: Final st: NotStopd t0: [04:00:00 23/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.7 rs: Final st: NotStopd
t0: [05:00:00 23/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 83.3333 u1: units st: NotStopd t0: [05:00:00 23/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 83.3333 u1: units st: NotStopd t0: [05:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [05:00:00 23/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [05:00:00 23/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.312 u1: L st: NotStopd t0: [05:00:00 23/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [05:00:00 23/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [05:00:00 23/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [05:30:00 23/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml t0: [05:30:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 45 vu: ml
t0: [06:00:00 23/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 96 rs: Manual st: NotStopd
t0: [06:00:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 15 vu: ml t0: [06:00:00 23/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 30 vu: ml t0: [06:00:00 23/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 300 vu: ml
t0: [06:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 53 u1: BPM st: NotStopd t0: [06:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [06:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [06:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [06:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 23/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [06:00:00 23/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [06:23:00 23/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd
tf: [06:00:00 24/05/2011] pt: IV Piggyback rt: IV fr: ONCE fs: 7 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [06:00:00 24/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 7 dn: 1 m1: Potassium Chloride v1: 60 u1: mEq
t0: [08:00:00 23/05/2011] id: D5W 250.0ml + 100mcgkgmin Nitroglycerine-k IV Infusions el: 1 cu: MICU cg: -1 ai: 112 vo: 0 st: D/C'd
t0: [08:00:00 23/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 23/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [08:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 23/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [08:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [08:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 23/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [08:00:00 23/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 23/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [08:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 168 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [08:00:00 23/05/2011] id: Pain Cause el: 0 cu: MICU cg: RN v1: At Rest st: NotStopd t0: [08:00:00 23/05/2011] id: Pain Location el: 0 cu: MICU cg: RN v1: Abdominal st: NotStopd t0: [08:00:00 23/05/2011] id: Pain Management el: 1 cu: MICU cg: RN v1: PO Med st: NotStopd t0: [08:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [08:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [08:00:00 23/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [08:00:00 23/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [08:00:00 23/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [08:00:00 23/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [08:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 22/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 0 vu: ml nb: 1 t0: [08:00:00 23/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 50 vu: ml t0: [08:00:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [08:00:00 23/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 120 vu: ml
t0: [08:00:00 23/05/2011] id: Nitroglycerine-k el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped
t0: [08:00:00 23/05/2011] tf: [14:07:00 24/05/2011] dt: 1807 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 75 vu: ml t0: [09:00:00 23/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 800 vu: ml
t0: [08:00:00 23/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 23/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 23/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi v2: Antacid st: NotStopd t0: [08:00:00 23/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 23/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 23/05/2011] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 23/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 23/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [08:00:00 23/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 23/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 23/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 23/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 23/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 23/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 23/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 23/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [08:00:00 23/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [08:00:00 23/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 23/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [08:00:00 23/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [08:00:00 23/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 23/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 23/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 23/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 23/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 23/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 23/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 23/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [08:00:00 23/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [08:00:00 23/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 23/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 23/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 23/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 23/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 23/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 23/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 23/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 23/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 23/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [08:00:00 23/05/2011] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 23/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 23/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 23/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 23/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 23/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 23/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 23/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 23/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.8333 u1: Deg. C st: NotStopd t0: [08:00:00 23/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 96.5 u1: Deg. F st: NotStopd t0: [08:00:00 23/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [08:00:00 23/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 23/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 23/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 23/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [08:00:00 23/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 23/05/2011] id: Bath el: 1 cu: MICU cg: RN v1: done t0: [08:00:00 23/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [09:00:00 23/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [09:00:00 23/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [09:00:00 23/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 23/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 23/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 23/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [09:00:00 23/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [09:00:00 23/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [09:00:00 23/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [09:00:00 23/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [09:00:00 23/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [09:00:00 23/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [04:00:00 23/05/2011] id: CPK/MB Enzymes el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd
tf: [08:00:00 24/05/2011] pt: Unit Dose rt: PO fr: ASDIR fs: 9 m1: Maalox/Benadryl/Lidocaine v1: 15 u1: ml
t0: [10:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [10:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [10:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [10:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [10:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 23/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [11:00:00 23/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [11:00:00 23/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [11:00:00 23/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 23/05/2011] id: Bath el: 1 cu: MICU cg: RN v1: done
t0: [09:00:00 23/05/2011] id: D5W 100.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 105 vo: 100 vu: ml t0: [09:00:00 23/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 180 vu: ml t0: [11:00:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 90 vu: ml t0: [11:00:00 23/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 30 vu: ml t0: [11:00:00 23/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 550 vu: ml
t0: [08:00:00 23/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 23/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 23/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [12:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 23/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 23/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 23/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi v2: Antacid st: NotStopd t0: [12:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 23/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 23/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 23/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 23/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 23/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [12:00:00 23/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 23/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 23/05/2011] id: GI#1 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 23/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 23/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 23/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [12:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 23/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [12:00:00 23/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [12:00:00 23/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 23/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [12:00:00 23/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [12:00:00 23/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 23/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 23/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 23/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [12:00:00 23/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 23/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 23/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 23/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [12:00:00 23/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [12:00:00 23/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 23/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [12:00:00 23/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Rash st: NotStopd t0: [12:00:00 23/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [12:00:00 23/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [12:00:00 23/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [12:00:00 23/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [12:00:00 23/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 23/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 23/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 23/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 23/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [12:00:00 23/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 23/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [12:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 187 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [12:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 128 u1: mmHg st: NotStopd t0: [12:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 23/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 23/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 23/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [12:00:00 23/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [12:00:00 23/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [12:00:00 23/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [12:00:00 23/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 23/05/2011] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [12:00:00 23/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 23/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 23/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 23/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [12:00:00 23/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [12:00:00 23/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [12:00:00 23/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [12:00:00 23/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [12:00:00 23/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [12:00:00 23/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 23/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [12:00:00 23/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [12:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 23/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [12:00:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [12:00:00 23/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml
t0: [12:00:00 23/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 165 rs: Manual st: NotStopd
t0: [12:00:00 23/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [14:00:00 23/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [14:00:00 23/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [14:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 23/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.5 u1: torr st: NotStopd t0: [14:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [14:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 23/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [14:00:00 23/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [14:00:00 23/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RN v1: Trach Mask st: NotStopd t0: [14:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 170 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [14:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [14:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [14:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [14:00:00 23/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [14:00:00 23/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [14:00:00 23/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [14:00:00 23/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [14:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 23/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 60 vu: ml t0: [14:00:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 60 vu: ml t0: [14:00:00 23/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml
t0: [14:00:00 23/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 900 vu: ml
tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Clonidine HCl v1: 0.2 u1: mg
t0: [08:00:00 23/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [08:00:00 23/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Flovent st: NotStopd t0: [12:00:00 23/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [16:00:00 23/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [16:00:00 23/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [16:00:00 23/05/2011] id: O2 Delivery Device el: 0 cu: MICU cg: RRT v1: Trach Mask st: NotStopd
t0: [16:45:00 23/05/2011] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.42 rs: Final st: NotStopd t0: [16:45:00 23/05/2011] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [16:45:00 23/05/2011] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 26 rs: Final st: NotStopd t0: [16:45:00 23/05/2011] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 39 u1: mmHg rs: Final st: NotStopd t0: [16:45:00 23/05/2011] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 91 u1: mmHg rs: Final st: NotStopd t0: [16:45:00 23/05/2011] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.42 rs: Final st: NotStopd
t0: [16:00:00 23/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd
t0: [16:00:00 23/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8 u1: mg/dl rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 150 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.8 u1: mEq/L rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8 u1: mg/dl rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 24 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 150 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.8 u1: mEq/L rs: Final st: NotStopd t0: [16:00:00 23/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [17:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 53 u1: BPM st: NotStopd t0: [17:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 167 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [17:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [17:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [17:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 23/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [17:00:00 23/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.9444 u1: Deg. C st: NotStopd t0: [17:00:00 23/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 96.7 u1: Deg. F st: NotStopd t0: [17:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 23/05/2011] id: Stool Out Stool el: 1 cu: MICU cg: RN vo: 380 vu: ml t0: [17:00:00 23/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 360 vu: ml
t0: [18:00:00 23/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [18:00:00 23/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [18:00:00 23/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 17 t0: [18:00:00 23/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [18:00:00 23/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [18:00:00 23/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [18:00:00 23/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [18:00:00 23/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [18:00:00 23/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [18:00:00 23/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5.5 st: NotStopd t0: [18:00:00 23/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [18:00:00 23/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.9 u1: L/min st: NotStopd t0: [18:00:00 23/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [18:00:00 23/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [18:00:00 23/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [18:00:00 23/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [18:00:00 23/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [18:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [18:00:00 23/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [18:00:00 23/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [18:00:00 23/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [18:00:00 23/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [18:00:00 23/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [18:00:00 23/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [18:00:00 23/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [15:00:00 23/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 23/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [15:00:00 23/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [15:00:00 23/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [15:00:00 23/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 23/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [18:00:00 23/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [18:00:00 23/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [18:00:00 23/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [18:00:00 23/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [18:00:00 23/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [18:00:00 23/05/2011] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [18:00:00 23/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [18:00:00 23/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [18:00:00 23/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [18:00:00 23/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [18:00:00 23/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [18:00:00 23/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [18:00:00 23/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 23/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 23/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [18:00:00 23/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 23/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 23/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [18:00:00 23/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [18:00:00 23/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [18:00:00 23/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 2 st: NotStopd t0: [18:00:00 23/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 23/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 23/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 23/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [18:00:00 23/05/2011] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 23/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 23/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [18:00:00 23/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 23/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [18:00:00 23/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [18:00:00 23/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 113 rs: Manual st: NotStopd t0: [18:00:00 23/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [17:00:00 23/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 30 vu: ml
t0: [16:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 49 u1: BPM st: NotStopd t0: [16:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [16:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [16:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [16:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [16:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [16:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 50 u1: BPM st: NotStopd t0: [18:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 168 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [18:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [18:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [18:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 23/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [20:00:00 23/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 23/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 17 t0: [20:00:00 23/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 23/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 23/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [20:00:00 23/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 23/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 33 u1: Deg. C st: NotStopd t0: [20:00:00 23/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [20:00:00 23/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:00:00 23/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:00:00 23/05/2011] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Flovent st: NotStopd t0: [20:00:00 23/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [20:00:00 23/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.3 u1: L/min st: NotStopd t0: [20:00:00 23/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 23/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 23/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [20:00:00 23/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 23 u1: BPM st: NotStopd t0: [20:00:00 23/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [20:00:00 23/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 400 u1: ml/B st: NotStopd t0: [20:00:00 23/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 23/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [20:00:00 23/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 23/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [20:00:00 23/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 23/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 23/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 23/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 23/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 23/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [20:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [20:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [20:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [20:00:00 23/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 23/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [20:00:00 23/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [20:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 23/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 30 vu: ml t0: [20:00:00 23/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 60 vu: ml
t0: [20:00:00 23/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [20:00:00 23/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [20:00:00 23/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 23/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [20:00:00 23/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [20:00:00 23/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 23/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 23/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [20:00:00 23/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 23/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 23/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [20:00:00 23/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [20:00:00 23/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd
t0: [22:00:00 23/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 23/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 23/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 23/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 23/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 23/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 23/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 53 u1: BPM st: NotStopd t0: [22:00:00 23/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 23/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [22:00:00 23/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [22:00:00 23/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 23/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [22:00:00 23/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 23/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 23/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 30 vu: ml t0: [23:00:00 23/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 120 vu: ml
t0: [23:00:00 23/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 120 cv: 120 ap: none t0: [23:00:00 23/05/2011] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 120 cv: 3750 ap: none t0: [23:00:00 23/05/2011] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 120 cv: 4530 ap: none
t0: [00:00:00 24/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [00:00:00 24/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 24/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 17 t0: [00:00:00 24/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 24/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [00:00:00 24/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [00:00:00 24/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 24/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [00:00:00 24/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [00:00:00 24/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 24/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [00:00:00 24/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [00:00:00 24/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.9 u1: L/min st: NotStopd t0: [00:00:00 24/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 24/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 24/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [00:00:00 24/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [00:00:00 24/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 24/05/2011] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 24/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 398 u1: ml/B st: NotStopd t0: [00:00:00 24/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 24/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [00:00:00 24/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 24/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [00:00:00 24/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 24/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 24/05/2011] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 24/05/2011] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd
t0: [00:00:00 24/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 24/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 24/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 24/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 24/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 24/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 24/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 24/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 24/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [00:00:00 24/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 24/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [00:00:00 24/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [00:00:00 24/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 24/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [00:00:00 24/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 24/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [00:00:00 24/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [00:00:00 24/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 24/05/2011] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 81 rs: Manual st: NotStopd t0: [01:00:00 24/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [01:00:00 24/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [01:00:00 24/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [01:00:00 24/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [01:00:00 24/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [01:00:00 24/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [01:00:00 24/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [01:00:00 24/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [01:00:00 24/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 24/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [01:00:00 24/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [01:00:00 24/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [01:00:00 24/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 24/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [01:00:00 24/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [01:00:00 24/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [01:00:00 24/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [01:00:00 24/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [01:00:00 24/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [01:00:00 24/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [01:00:00 24/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 24/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [01:00:00 24/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [01:00:00 24/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [01:00:00 24/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [01:00:00 24/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [01:00:00 24/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [01:00:00 24/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 24/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [01:00:00 24/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [01:00:00 24/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 24/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 24/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [01:00:00 24/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [01:00:00 24/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 24/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [01:00:00 24/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 24/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [01:00:00 24/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [01:00:00 24/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 24/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 24/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [01:00:00 24/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 24/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [01:00:00 24/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [01:00:00 24/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [01:00:00 24/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [01:00:00 24/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 24/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [01:00:00 24/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 20 vu: ml t0: [01:00:00 24/05/2011] id: Gastric Meds PO/Gastric el: 1 cu: MICU cg: RN ai: 155 vo: 60 vu: ml t0: [01:00:00 24/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 130 vu: ml
t0: [23:00:00 24/05/2011] dt: 24 id: PO/Gastric In Total el: 2 cu: -1 cg: RN cv: 60 ap: none
t0: [02:00:00 24/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 24/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 24/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 24/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 24/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 24/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 24/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 52 u1: BPM st: NotStopd t0: [02:00:00 24/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 24/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [02:00:00 24/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [02:00:00 24/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 24/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [02:00:00 24/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 24/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 90 vu: ml st: Stopped t0: [20:00:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vu: ml t0: [23:00:00 23/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vu: ml t0: [01:00:00 24/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vu: ml t0: [02:30:00 24/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 0 vu: ml nb: 1 t0: [02:30:00 24/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 15 vu: ml t0: [02:30:00 24/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 140 vu: ml
t0: [23:00:00 23/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -90 cv: -90 ap: none t0: [23:00:00 23/05/2011] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 30 cv: 1535 ap: none t0: [23:00:00 23/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 570 ap: none t0: [23:00:00 23/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -90 cv: -2995 ap: none t0: [23:00:00 23/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -90 cv: 4147.62 ap: carryForward t0: [23:00:00 24/05/2011] dt: 1 id: Total Hourly Output el: 2 cu: -1 cg: RN cv: 0 ap: none t0: [23:00:00 24/05/2011] dt: 1 id: Net Hourly Balance el: 2 cu: -1 cg: RN cv: 0 ap: none t0: [23:00:00 24/05/2011] dt: 24 id: IV Infusion In Total el: 2 cu: -1 cg: RN cv: 90 ap: none t0: [23:00:00 24/05/2011] dt: 24 id: 24h Total In el: 2 cu: -1 cg: RN cv: 290 ap: none t0: [23:00:00 24/05/2011] dt: 24 id: Tube Feeds In Total el: 2 cu: -1 cg: RN cv: 140 ap: none t0: [23:00:00 24/05/2011] dt: 24 id: Urine Out Total el: 2 cu: -1 cg: RN cv: 940 ap: none t0: [23:00:00 24/05/2011] dt: 24 id: 24h Net Body Balance el: 2 cu: -1 cg: RN cv: -650 ap: none t0: [23:00:00 24/05/2011] dt: 24 id: 24h Total Out el: 2 cu: -1 cg: RN cv: 940 ap: none t0: [23:00:00 24/05/2011] dt: multiple days id: LOS Net Body Balance el: 2 cu: -1 cg: RN cv: 3497.62 ap: carryForward
t0: [04:00:00 24/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 24/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 24/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 24/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 24/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 24/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 24/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 52 u1: BPM st: NotStopd t0: [04:00:00 24/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [04:00:00 24/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 24/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [04:00:00 24/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [04:00:00 24/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 24/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [04:00:00 24/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 24/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 24/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 3 v2: 26 st: NotStopd t0: [04:00:00 24/05/2011] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 24/05/2011] id: high exhale MV el: 0 cu: MICU cg: RRT v1: 17 t0: [04:00:00 24/05/2011] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 24/05/2011] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [04:00:00 24/05/2011] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [04:00:00 24/05/2011] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 24/05/2011] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.6 u1: Deg. C st: NotStopd t0: [04:00:00 24/05/2011] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 3 v2: 12 st: NotStopd t0: [04:00:00 24/05/2011] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [04:00:00 24/05/2011] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:00:00 24/05/2011] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:00:00 24/05/2011] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 6.9 u1: L/min st: NotStopd t0: [04:00:00 24/05/2011] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 24/05/2011] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 24/05/2011] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 5 u1: . st: NotStopd t0: [04:00:00 24/05/2011] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 21 u1: BPM st: NotStopd t0: [04:00:00 24/05/2011] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:00:00 24/05/2011] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 345 u1: ml/B st: NotStopd t0: [04:00:00 24/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 24/05/2011] id: Trach Size el: 0 cu: MICU cg: RRT v1: #6 st: NotStopd t0: [04:00:00 24/05/2011] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 24/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Shiley st: NotStopd t0: [04:00:00 24/05/2011] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:00:00 24/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [04:00:00 24/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 6.2 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 6.2 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 34.1 u1: % rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 11.7 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 230 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.99 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 6.2 rs: Final st: NotStopd
t0: [04:00:00 24/05/2011] id: BUN el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 73 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.6 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 25 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 73 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.6 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd
t0: [04:00:00 24/05/2011] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3 rs: Final st: NotStopd
t0: [04:00:00 24/05/2011] id: Differential-Basos Hematology el: 0 cu: MICU cg: 1663 v1: 0.1 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Differential-Eos Hematology el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Differential-Lymphs Hematology el: 0 cu: MICU cg: 1663 v1: 7.6 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Differential-Monos Hematology el: 0 cu: MICU cg: 1663 v1: 5 rs: Final st: NotStopd t0: [04:00:00 24/05/2011] id: Differential-Polys Hematology el: 0 cu: MICU cg: 1663 v1: 86.3 rs: Final st: NotStopd
t0: [06:00:00 24/05/2011] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 68.9655 u1: units st: NotStopd t0: [06:00:00 24/05/2011] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 68.9655 u1: units st: NotStopd t0: [06:00:00 24/05/2011] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [06:00:00 24/05/2011] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.348 u1: L st: NotStopd
t0: [07:00:00 24/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 24/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 24/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 24/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 24/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 24/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 24/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [07:00:00 24/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 24/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [07:00:00 24/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [07:00:00 24/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 24/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [07:00:00 24/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 24/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 24/05/2011] id: Vivonex Tube Feeding el: 1 cu: MICU cg: RN ai: 107 vo: 140 vu: ml st: Stopped t0: [07:00:00 24/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 45 vu: ml t0: [07:00:00 24/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 525 vu: ml
t0: [08:00:00 24/05/2011] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 24/05/2011] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [08:00:00 24/05/2011] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 24/05/2011] id: Chest PT R/L el: 0 cu: MICU cg: RN v1: Done v2: Done st: NotStopd t0: [08:00:00 24/05/2011] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 24/05/2011] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 24/05/2011] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 24/05/2011] id: Cough Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 24/05/2011] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 24/05/2011] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 24/05/2011] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 24/05/2011] id: Diet Type el: 0 cu: MICU cg: RN v1: NPO st: NotStopd t0: [08:00:00 24/05/2011] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 24/05/2011] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 24/05/2011] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 24/05/2011] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 24/05/2011] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 24/05/2011] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General st: NotStopd t0: [08:00:00 24/05/2011] id: GI#1 Intub Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [08:00:00 24/05/2011] id: Health Care Proxy el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 24/05/2011] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 24/05/2011] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 24/05/2011] id: GI Intub #1/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Left Nare st: NotStopd t0: [08:00:00 24/05/2011] id: GI#1 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 24/05/2011] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 24/05/2011] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 24/05/2011] id: Gag Reflex el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 24/05/2011] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 24/05/2011] id: Heart Rate el: 0 cu: MICU cg: RN v1: 52 u1: BPM st: NotStopd t0: [08:00:00 24/05/2011] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [08:00:00 24/05/2011] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Right Brachial st: NotStopd t0: [08:00:00 24/05/2011] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [08:00:00 24/05/2011] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 24/05/2011] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Brachial st: NotStopd t0: [08:00:00 24/05/2011] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 4 v2: 1 st: NotStopd t0: [08:00:00 24/05/2011] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 24/05/2011] id: INV Line#3 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 24/05/2011] id: INV Line#3 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 24/05/2011] id: INV Line#3InsertDate el: 0 cu: MICU cg: RN v1: 3 v2: 21 st: NotStopd t0: [08:00:00 24/05/2011] id: INV Line#3SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 24/05/2011] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 24/05/2011] id: INV#3 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 24/05/2011] id: IV #1 Insert Date el: 0 cu: MICU cg: RN v1: 4 v2: 2 st: NotStopd t0: [08:00:00 24/05/2011] id: IV #1 Site/Size el: 0 cu: MICU cg: RN v1: Right Hand v2: 18 gauge st: NotStopd t0: [08:00:00 24/05/2011] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 24/05/2011] id: IV Site Appear #1 el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 24/05/2011] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 24/05/2011] id: Imp Skin Cleanse #2 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [08:00:00 24/05/2011] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 24/05/2011] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 24/05/2011] id: ImpSkin Wound Base#2 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [08:00:00 24/05/2011] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Perineum st: NotStopd t0: [08:00:00 24/05/2011] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 24/05/2011] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 24/05/2011] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 24/05/2011] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 24/05/2011] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 24/05/2011] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [08:00:00 24/05/2011] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [08:00:00 24/05/2011] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 24/05/2011] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 24/05/2011] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 24/05/2011] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 24/05/2011] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 24/05/2011] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [08:00:00 24/05/2011] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 24/05/2011] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 24/05/2011] id: Skin Color el: 0 cu: MICU cg: RN v1: Normal for Race st: NotStopd t0: [08:00:00 24/05/2011] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 24/05/2011] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 24/05/2011] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [08:00:00 24/05/2011] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 24/05/2011] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 24/05/2011] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 24/05/2011] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 24/05/2011] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [08:00:00 24/05/2011] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [08:00:00 24/05/2011] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AtmosAir Mattres st: NotStopd t0: [08:00:00 24/05/2011] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 24/05/2011] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:00:00 24/05/2011] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 24/05/2011] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 24/05/2011] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 24/05/2011] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 24/05/2011] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 24/05/2011] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 24/05/2011] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 24/05/2011] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 24/05/2011] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 24/05/2011] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 24/05/2011] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 24/05/2011] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 24/05/2011] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [08:00:00 24/05/2011] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 24/05/2011] id: Urine Out Foley el: 1 cu: MICU cg: RN vo: 145 vu: ml
t0: [08:00:00 24/05/2011] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 24/05/2011] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [08:00:00 24/05/2011] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 24/05/2011] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd
t0: [08:00:00 24/05/2011] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 3 v2: 26 st: NotStopd t0: [08:00:00 24/05/2011] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [08:00:00 24/05/2011] id: Intubation Date el: 0 cu: MICU cg: RN v1: 3 v2: 12 st: NotStopd t0: [08:00:00 24/05/2011] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [08:00:00 24/05/2011] id: Trach Size el: 0 cu: MICU cg: RN v1: #6 st: NotStopd t0: [08:00:00 24/05/2011] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Shiley st: NotStopd t0: [08:00:00 24/05/2011] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd
tf: [18:00:00 24/05/2011] pt: IV Piggyback rt: IV fr: ASDIR fs: 10 m1: Potassium Chloride v1: 40 u1: mEq m2: NS v2: 500 u2: ml tf: [18:00:00 24/05/2011] pt: Unit Dose rt: PO fr: ONCE fs: 10 dn: 1 m1: Potassium Chloride v1: 60 u1: mEq
dd: 4928 ds: 2 ld: EMPHYSEMA NEC dd: 51889 ds: 1 ld: OTHER LUNG DISEASE NEC dd: V149 ds: 3 ld: HX-DRUG ALLERGY NOS
dd: 4019 ds: 1 ld: HYPERTENSION NOS
dd: 4019 ds: 1 ld: HYPERTENSION NOS dd: 4299 ds: 2 ld: HEART DISEASE NOS
dd: 36612 ds: 1 ld: INCIPIENT CATARACT
dd: 3669 ds: 1 ld: CATARACT NOS dd: 4019 ds: 3 ld: HYPERTENSION NOS dd: 496 ds: 2 ld: CHR AIRWAY OBSTRUCT NEC
dd: 36616 ds: 1 ld: SENILE NUCLEAR CATARACT
dd: 4659 ds: 1 ld: ACUTE URI NOS
dd: 2720 ds: 2 ld: PURE HYPERCHOLESTEROLEM dd: 2724 ds: 4 ld: HYPERLIPIDEMIA NEC/NOS dd: 4019 ds: 1 ld: HYPERTENSION NOS dd: 496 ds: 3 ld: CHR AIRWAY OBSTRUCT NEC