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    Fluid Balance Chart: Fluid Intake Fluid Output

    Uploaded by

    Nely
    This fluid balance chart tracks the fluid intake and output of a patient named Silfa over a 24 hour period from 1:00 to 24:00 on August 18th, 2020 while staying in the Rose Room at Smile Hospital. It shows that the patient had a total oral fluid intake of 1100ml and intravenous intake of 2400ml, with total fluid output of 680ml of urine, 400ml of vomit, and 200ml of other output. The chart is used to monitor the patient's fluid balance.

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    Fluid Balance Chart: Fluid Intake Fluid Output

    Uploaded by

    Nely
    59 views3 pages
    This fluid balance chart tracks the fluid intake and output of a patient named Silfa over a 24 hour period from 1:00 to 24:00 on August 18th, 2020 while staying in the Rose Room at Smile Hospital. It shows that the patient had a total oral fluid intake of 1100ml and intravenous intake of 2400ml, with total fluid output of 680ml of urine, 400ml of vomit, and 200ml of other output. The chart is used to monitor the patient's fluid balance.

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    2A-silfa safira.docx

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    This fluid balance chart tracks the fluid intake and output of a patient named Silfa over a 24 hour period from 1:00 to 24:00 on August 18th, 2020 while staying in the Rose Room at Smile Hospital. It shows that the patient had a total oral fluid intake of 1100ml and intravenous intake of 2400ml, with total fluid output of 680ml of urine, 400ml of vomit, and 200ml of other output. The chart is used to monitor the patient's fluid balance.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    59 views3 pages

    Fluid Balance Chart: Fluid Intake Fluid Output

    Uploaded by

    Nely
    This fluid balance chart tracks the fluid intake and output of a patient named Silfa over a 24 hour period from 1:00 to 24:00 on August 18th, 2020 while staying in the Rose Room at Smile Hospital. It shows that the patient had a total oral fluid intake of 1100ml and intravenous intake of 2400ml, with total fluid output of 680ml of urine, 400ml of vomit, and 200ml of other output. The chart is used to monitor the patient's fluid balance.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Fluid balance chart

    Hospital/Ward : Smile Hospital/ Rose Room Date: 18th Augest 2020


    Hospital number: 081477067785
    Surname : fira
    Forenames : silfa
    Date of birth : 3rd November 2001
    Sex : Female
    Fluid intake Fluid output
    Time (hrs) Oral IV Other (specify route) Urine Vomit Other (specify)
    01.00 100 cc
    02.00 100 cc
    03.00 50 ml 100 cc
    04.00 100 cc 200 ml
    05.00 100 cc
    06.00 100 cc
    07.00 250 ml 100 cc 100 ml
    08.00 100 cc 5 cc (injection) 80 ml
    09.00 200 ml 100 cc 100 mml
    (defecate)
    10.00 100 cc
    11.00 100 ml 100 cc 100 ml
    12.00 100 ml 100 cc
    13.00 100 cc 100 ml
    14.00 100 cc
    15.00 200 ml 100 cc 200 ml 50 ml
    16.00 100 cc
    17.00 50 ml 100 cc 100 ml
    (defecate)
    18.00 100 cc
    19.00 100 ml 100 cc 5 cc (injection) 100 ml
    20.00 100 cc 50 ml
    21.00 100 cc
    22.00 50 ml 100 cc
    23.00 100 cc 50 ml
    24.00 100 cc 50 ml
    TOTAL 1100 2400 10 ml 680 ml 400 ml 200 ml
    ml ml
    CONSENT WAIVER OF MEDICAL / SURGERY
    I who signed under this :

    Name : Fira
    Age : 42 years old
    Gender : Male / Female
    Address : Desa Comal,Pemalang
    Phone : 081477067785
    Relation to the patient : Parent (Mother)

    Patient’s name : Bambang


    Age : 5 years old
    Gender : Male / Female
    Address : Desa petarukan,pemalang
    Phone : 085741142504
    Treated at : Room Rose Class VIP
    Medical record number : 001-67-570
    Pre-oreation diagnose : Hernia

    Hereby agrees to be taken medical / surgery :


    Hernia surgery Of the patient with / without general anesthesia / local.
    I make this statement with the fact that:
    1. Explanation has been given by the doctor about the patient’s disease, treatment options,
    and medical action / treatment as well as the dangers, risk, and possibilities for action
    arising from the medicial, and fully understood the explanation given by the doctor.
    (Fira/ initials)
    2. I also agreed to do further medicial treatment, if necessary for the patient’s safety.
    (Fira/ initials)

     Type of medical treatment / surgery : Hernia Surgery

     Type of examination patologi anatomy : USG Abdomen

    Pemalnag,18th Augest 2020


    Doctor who explain That makes steatement

    Dr. Bambang, Sp.B silfa safira


    1st Withness (from hospital) 2nd Withness (from family)
    Rahma Azizah, S.Kep Manora Rina

    Name : silfa safira


    Class : 2A
    NIM : P1337421019017

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