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I: Initiating / Maintaining Peripheral IV Infusions
Patient No: Name of Patient Age Date Time Kinds of
fusions
Site Type of
Cannula
Dose Rate
Signature over Printed Name
of Certified
Trainer/Preceptor
License No:
1. Alcazar, Chloe 10 y/o 09-22-23 12:00 pm D5NM R Metacarpal Vein G-24 1L x 12 hrs 83ugtts/min Grace Marithel Montierro AN: 07-5963
2. Gutierrez, Xiara 5 y/o 09-25-23 10:00 am D5LR R Metacarpal Vein G-26 1L x 24hrs 40 ugtts/min Grace Marithel Montierro AN: 07-5963
3. Obrador, Keith 10 y/o 09-28-23 10:45 pm PNSS L Cephalic Vein G-22 500 cc x kvo 10 ugtts/min Grace Marithel Montierro AN: 07-5963
II. Administering Intravenous Drugs
Patient No: Name of Patient Age Date Time Drugs Incorporated Dose Diagnosis
Signature over Printed Name
of Certified
Trainer/Preceptor
License No:
1. Pamilar, Rienz Dylan 2 mos. old 09-28-23 4:00 am Amikacin 250mg/2mL 67.5mg IV OD Pneumonia Grace Marithel Montierro AN: 07-5963
2. Obrador, Keith 10 y/o 09-28-23 6:00 am Omeprazole 40mg vial 20 mg IV OD Dengue Fever Syndrome Grace Marithel Montierro AN: 07-5963
3. Velasquez, Arkien 2 mos. old 09-29-23 8:00 am Hydrocortisone100mg vial 26 mg IV q6 hrs PCAP Grace Marithel Montierro AN: 07-5963
III. Administering & Maintaining Blood and Blood Components(2 NURSES IN ONE BLOOD TRANSFUSION ADMINISTRATION
Patient No: Name of Patient Age Date Time Volume/Blood Type
Components/Rate
IV Insertion Type of
Cannula
Diagnosis
Signature over Printed Name
of Certified
Trainer/Preceptor
License No:
1. Pojadas, Josephine 49 y/o 09-08-23 9:30 pm Type O Rh (+) 250cc
PRBC x 21gtts
R Metacarpal Vein G-18 Upper GI Bleeding Angelyn Marcelo AN: 07-7129
3+3+1 ACCOMPLISHED REQUIREMENT of
3 – DAYS BASIC INFUSION THERAPY TRAINING PROGRAM for NURSES
Name of Registered Nurse: Rilbonn Glare Almocera Reyes PRC Number: 06-71973
Name of Hospital Offering IV Training: San Pablo Colleges Medical Center Provider No: 155
Date of I V Training Program Attended: August 24-26, 2023 Venue: 4th
Floor Central Bldg AVR SPCMC
Submitted by: Rilbonn Glare A. Reyes Date Submitted: October 2, 2023 Received by: Approved by: Rowena P. Bati RN, MAN
Director, Nursing Service
(Signature over printed Name)
(Signature over printed Name)
RGREYES IVT OCT 2.pdf

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RGREYES IVT OCT 2.pdf

  • 1. I: Initiating / Maintaining Peripheral IV Infusions Patient No: Name of Patient Age Date Time Kinds of fusions Site Type of Cannula Dose Rate Signature over Printed Name of Certified Trainer/Preceptor License No: 1. Alcazar, Chloe 10 y/o 09-22-23 12:00 pm D5NM R Metacarpal Vein G-24 1L x 12 hrs 83ugtts/min Grace Marithel Montierro AN: 07-5963 2. Gutierrez, Xiara 5 y/o 09-25-23 10:00 am D5LR R Metacarpal Vein G-26 1L x 24hrs 40 ugtts/min Grace Marithel Montierro AN: 07-5963 3. Obrador, Keith 10 y/o 09-28-23 10:45 pm PNSS L Cephalic Vein G-22 500 cc x kvo 10 ugtts/min Grace Marithel Montierro AN: 07-5963 II. Administering Intravenous Drugs Patient No: Name of Patient Age Date Time Drugs Incorporated Dose Diagnosis Signature over Printed Name of Certified Trainer/Preceptor License No: 1. Pamilar, Rienz Dylan 2 mos. old 09-28-23 4:00 am Amikacin 250mg/2mL 67.5mg IV OD Pneumonia Grace Marithel Montierro AN: 07-5963 2. Obrador, Keith 10 y/o 09-28-23 6:00 am Omeprazole 40mg vial 20 mg IV OD Dengue Fever Syndrome Grace Marithel Montierro AN: 07-5963 3. Velasquez, Arkien 2 mos. old 09-29-23 8:00 am Hydrocortisone100mg vial 26 mg IV q6 hrs PCAP Grace Marithel Montierro AN: 07-5963 III. Administering & Maintaining Blood and Blood Components(2 NURSES IN ONE BLOOD TRANSFUSION ADMINISTRATION Patient No: Name of Patient Age Date Time Volume/Blood Type Components/Rate IV Insertion Type of Cannula Diagnosis Signature over Printed Name of Certified Trainer/Preceptor License No: 1. Pojadas, Josephine 49 y/o 09-08-23 9:30 pm Type O Rh (+) 250cc PRBC x 21gtts R Metacarpal Vein G-18 Upper GI Bleeding Angelyn Marcelo AN: 07-7129 3+3+1 ACCOMPLISHED REQUIREMENT of 3 – DAYS BASIC INFUSION THERAPY TRAINING PROGRAM for NURSES Name of Registered Nurse: Rilbonn Glare Almocera Reyes PRC Number: 06-71973 Name of Hospital Offering IV Training: San Pablo Colleges Medical Center Provider No: 155 Date of I V Training Program Attended: August 24-26, 2023 Venue: 4th Floor Central Bldg AVR SPCMC Submitted by: Rilbonn Glare A. Reyes Date Submitted: October 2, 2023 Received by: Approved by: Rowena P. Bati RN, MAN Director, Nursing Service (Signature over printed Name) (Signature over printed Name)