HOLY NAME UNIVERSITY SIMULATION HOSPITAL
College of Health Sciences - Nursing Department
City of Tagbilaran 6300
THERAPEUTIC SHEET
yrs.old
3
2022-123456
KC
F Ward: _____________Bed
Pulmo
Name: _________________________
Age: 5______Sex:
____
No._____Hosp.No.___________
Date and
Time
Ordered
Medication/Dosage/
Frequency/ Route
DATE
SHIFT
25
3/ drp
12-8
April 25,
2022 @ 10
am
PenicillinG Na 2 mil units
every 8 hours IVTT
8-4
4-12
11/ drp
7/ drp
12-8
April 25,
2022 @ 10
am
Salbutamol 1 nebule q4h
via Inhalation
Paracetamol 10 mL PO
q4h PRN for temp ≥38◦C
P.O.
11/ drp
7/ drp
2/ drp, 6/drp
27
3/ drp
11/ drp
7/ drp
28
3/ drp
11/ drp
2/ drp, 6/drp
7/ drp
2/ drp, 6/drp
8-4
10/ drp ,2/ drp
10/ drp ,2/ drp
10 drp, 2/drp
10 drp, 2/drp
4-12
6/ drp, 10/ drp
6/drp, 10/drp
6/drp, 10/drp
2/ drp, 6/drp
6/drp, 8/drp
6/ drp
12-8
April 25,
2022 @ 10
am
26
8-4
10/ drp , 2/ drp
4-12
6/ drp
6/ drp
12-8
8-4
4-12
12-8
8-4
4-12
12-8
8-4
4-12
HNU-CHS-SH November 2020