Live print preview

Your shift sheet

Soft color

Date: ___________Shift: ___________Nurse: ___________

NursingWorksheets.comOncology / Infusion

PATIENT 1

Name:

Rm: ____

Age: ____

Allergies:

Code: ____

MD:

Dx:

VITALS

	0700	0900	1100	1300	1500	1700
HR
BP
RR
Temp
SpO2
Pain

CHEMO PROTOCOL

Regimen:

Cycle / Day:

BSA (m²):

PRE-MEDICATIONS

Drug	Dose	Time	Given

REACTION MONITORING

Time	VS	Symptoms

LAB THRESHOLDS

ANC: ____ Hold: ____

Platelets: ____ Hold: ____

Cr/GFR: ____ Hold: ____

LFTs: ____ Hold: ____

CENTRAL LINE / PORT CARE

MEDICATIONS

Drug / Dose / Route	Time	Given	Notes

LABS

Na:

BUN:

Cr:

Glu:

WBC:

Hgb:

Plt:

Other:

IV ACCESS

Site/Gauge:

Fluid/Rate:

Date:

I&O

INTAKE

PO:

IV:

Blood:

Other:

Total:

OUTPUT

Urine:

Drain:

Emesis:

Other:

Total:

ASSESSMENT

PLAN / TASKS

NOTES

PATIENT 2

Name:

Rm: ____

Age: ____

Allergies:

Code: ____

MD:

Dx:

VITALS

	0700	0900	1100	1300	1500	1700
HR
BP
RR
Temp
SpO2
Pain

CHEMO PROTOCOL

Regimen:

Cycle / Day:

BSA (m²):

PRE-MEDICATIONS

Drug	Dose	Time	Given

REACTION MONITORING

Time	VS	Symptoms

LAB THRESHOLDS

ANC: ____ Hold: ____

Platelets: ____ Hold: ____

Cr/GFR: ____ Hold: ____

LFTs: ____ Hold: ____

CENTRAL LINE / PORT CARE

MEDICATIONS

Drug / Dose / Route	Time	Given	Notes

LABS

Na:

BUN:

Cr:

Glu:

WBC:

Hgb:

Plt:

Other:

IV ACCESS

Site/Gauge:

Fluid/Rate:

Date:

I&O

INTAKE

PO:

IV:

Blood:

Other:

Total:

OUTPUT

Urine:

Drain:

Emesis:

Other:

Total:

ASSESSMENT

PLAN / TASKS

NOTES

Date: ___________Shift: ___________Nurse: ___________

NursingWorksheets.comOncology / Infusion

PATIENT 3

Name:

Rm: ____

Age: ____

Allergies:

Code: ____

MD:

Dx:

VITALS

	0700	0900	1100	1300	1500	1700
HR
BP
RR
Temp
SpO2
Pain

CHEMO PROTOCOL

Regimen:

Cycle / Day:

BSA (m²):

PRE-MEDICATIONS

Drug	Dose	Time	Given

REACTION MONITORING

Time	VS	Symptoms

LAB THRESHOLDS

ANC: ____ Hold: ____

Platelets: ____ Hold: ____

Cr/GFR: ____ Hold: ____

LFTs: ____ Hold: ____

CENTRAL LINE / PORT CARE

MEDICATIONS

Drug / Dose / Route	Time	Given	Notes

LABS

Na:

BUN:

Cr:

Glu:

WBC:

Hgb:

Plt:

Other:

IV ACCESS

Site/Gauge:

Fluid/Rate:

Date:

I&O

INTAKE

PO:

IV:

Blood:

Other:

Total:

OUTPUT

Urine:

Drain:

Emesis:

Other:

Total:

ASSESSMENT

PLAN / TASKS

NOTES

Build a Oncology / Infusion brain sheet

Build settings

Assignment

Sections

Finish

Your shift sheet