ICU Nurse Report
ICU Nurse Report
This template was officially written/prepared/created by: [Your Name]
I. Patient Information
|
Patient Name: |
Josephine Smith |
|
Age: |
75 |
|
Gender: |
Female |
|
Admission Date: |
January 15, 2050 |
|
Emergency Contact: |
Brandon Jones |
|
Relation: |
Son |
|
Phone: |
[phone number] |
II. Medical History
Past Medical Conditions
-
Hypertension
-
Diabetes
-
Coronary Artery Disease
Allergies
-
Penicillin
-
Sulfa Drugs
III. Current Condition
Vital Signs
|
Parameter |
Value |
Unit |
|---|---|---|
|
Temperature |
98.6 |
°F |
|
Heart Rate |
80 |
bpm |
|
Blood Pressure |
120/80 |
mmHg |
Medications
-
Medication 1: Lisinopril - 10 mg daily
-
Medication 2: Metformin - 500 mg twice daily
IV. Treatment Plan
Current Interventions
-
Intubation
-
IV Fluids
-
Oxygen Therapy
Future Interventions
-
Daily Blood Tests
-
CT Scan scheduled for January 20, 2050
V. Nurse Notes
|
Date |
Time |
Notes |
Nurse Name |
|---|---|---|---|
|
January 15, 2050 |
08:00 AM |
Admitted to ICU; intubated |
Mary Smith |
|
January 16, 2050 |
08:00 AM |
Stable overnight; no complications |
Susan Clark |
VI. Contact Details
-
Email: [Your Company Email]
-
Phone: [Your Company Number]
-
Website: [Your Company Website]
-
Social Media: [Your Company Social Media]
