Welcome to the Nursing Brainsheet Database by NRSNG.com.
I remember how hard it was in nursing school and as a new nurse to find a brainsheet that
“worked” for me. They all either didn’t have enough space for notes or too much or were missing
that ONE thing I needed.
Eventually, after several months on the floor in the ICU I finally found a report sheet (brainsheet)
method that worked for me.
I guess what I am trying to say is that I get it . . . there is no one size fits all brainsheet so guess
what we did . . .
We went to the source!
We asked nurses and nursing students working in the ICU, ED, MedSurg, OB, Peds . . . anywhere
to send us their brainsheet so we could create the end-all-be-all database of brainsheets.
The response was AMAZING.
We received over 100 example brainsheets.
This database includes the top 33. We will continue to grow
the database as time goes on. You can see the most up to date
version at NursingBrainSheets.com.
What is NRSNG?
Glad you asked . . . it’s NURSING without the vowels . . . get it?
My experience with nursing education sucked (to put it gently).
So in 2014 I set out on a mission to change the way nurses
are educated . . . and NRSNG.com was born.
We believe that through engaging students, providing
support and basically giving a damn that nursing students
can not only LEARN how to be a nurse, but enjoy it too.
The NRSNG family has now reached all 50 states and over
185 countries from Afghanistan to Zimbabwe . . . literally.
So welcome aboard . . . we are glad to have you!
Happy Nursing!
-Jon Haws RN BSN CCRN
CEO/Founder NRSNG.com
p.s. Join us on social media and say “HI” (FB, IG, Snapchat, Twitter,
YouTube, Pinterest . . . you get the idea).
HANDOFF AND REPORT SHEET
NAME
AGE
ALLERGIES
CODE
DX
BACKGROUND
PMH
PSH
DOCTORS:
NEUROLOGICAL
Orientation
Pupils
Extremities
Follows Commands
Speech Clarity
Behavior
Sensation
Orientation
RESPIRATORY
O2 Delivery
Normal Stats
Lung Sounds
SKIN
Breakdown
Status of surgical sites
Dressings to change
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HANDOFF AND REPORT SHEET
CARDIAC
Rhythm, Rate, Trends
BP Trends
Medication available for control
Pulse location, strength, cap refill
Edema
SCDs, TEDS, VTE Prophylaxis
Fluids/Drips
Temps
GASTROINTESTINAL
Diet/tolerance/residuals
BM date/pattern
Nausea/Vomiting
Blood sugars/type of insulin/SCIP?
GENITOURINARY
Method
Type, amount, color
Dialysis/Schedule
PAIN
Sources of pain
Pain control/last PRN meds
Pain levels
PLAN FOR PATIENT
Discharge plans
Upcomming procedures
PRN meds
Family dynamics
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ULTIMATE CLINICAL BRAIN SHEET
REASON FOR HOSPITALIZATION:
FOCUSED ASSESSMENT:
ASSESSMENT NOTES:
CONSULTATION/TESTS:
PATIENT MEDICATIONS:
NAME
REASON
CONSIDERATIONS
TIME
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ULTIMATE CLINICAL BRAIN SHEET
INTAKE & OUTPUT
LAB VALUES
Na
135-148
WBC
3.6-9.2
Platelet
140-400
K
3.5-5.3
RBC male
4.39-5.58
Albumin
3.5-5.0
Cl
100-112
RBC female
3.70-5.14
Ca
8.3-10.3
CO2
23-29
Hgb male
13.7-17.3
PT
10.4-12.2
BUN
5.0 - 25.0
Hgb female
12-15.5
aPTT
24-33
Creat
0.5 - 1.7
Hct male
39-49
INR
2.0-3.0
pH
7.35-7.45
Hct female
35-46
Billirubin
0.0-1.0
PATIENT VITALS:
Time
Time
Time
Pulse
Pulse
Pulse
Pulse Ox
Pulse Ox
Pulse Ox
Respirations
Respirations
Respirations
BP
BP
BP
Temp
Temp
Temp
Pain
Pain
Pain
Time
Time
Time
Pulse
Pulse
Pulse
Pulse Ox
Pulse Ox
Pulse Ox
Respirations
Respirations
Respirations
BP
BP
BP
Temp
Temp
Temp
Pain
Pain
Pain
IV SITE ASSESSMENT/
FLUID/RATE
CALCULATIONS
TASKS/NOTES
THINGS TO RESEARCH/
IMPROVE
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PATIENTS SIMPLE BRAINSHEET
Name:
CX
IV:
Tele:
Admin
Fluids:
DX:
BS:
Res
Dr:
Diet:
HX:
O2:
C
Neuro:
CP
Mobi:
E
L
Res
D
W
GU:
GI:
T
Skin:
Pain:
T
Iso
T
Name:
CX
IV:
Tele:
Admin
Fluids:
DX:
BS:
Res
Dr:
Diet:
HX:
O2:
C
Neuro:
CP
Mobi:
E
L
Res
D
W
GU:
GI:
Skin:
T
Pain:
T
Iso
T
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PATIENTS SIMPLE BRAINSHEET
Name:
CX
IV:
Tele:
Admin
Fluids:
DX:
BS:
Res
Dr:
Diet:
HX:
O2:
C
Neuro:
CP
Mobi:
E
L
Res
D
W
GU:
GI:
T
Skin:
Pain:
T
Iso
T
Name:
CX
IV:
Tele:
Admin
Fluids:
DX:
BS:
Res
Dr:
Diet:
HX:
O2:
C
Neuro:
CP
Mobi:
E
L
Res
D
W
GU:
GI:
Skin:
T
Pain:
T
Iso
T
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PATIENTS SIMPLE BRAINSHEET
PATIENT ID LABEL
PATIENT ID LABEL
Meds
Meds
FS
FS
IV
IV
O2
O2
Tele
Foley
BM
Pain Med
Tests
Tele
Foley
Pain Med
Tests
Last Pain Med
Last FS
Last Pain Med
PATIENT ID LABEL
PATIENT ID LABEL
Meds
Meds
FS
FS
IV
IV
O2
O2
Tele
BM
Foley
BM
Pain Med
Tests
Last Pain Med
Tele
Foley
Last FS
BM
Pain Med
Tests
Last FS
Last Pain Med
Last FS
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PATIENTS SIMPLE BRAINSHEET
PATIENT ID LABEL
PATIENT ID LABEL
Meds
Meds
FS
FS
IV
IV
O2
O2
Tele
Foley
BM
Pain Med
Tele
Foley
Last FS
Last Pain Med
Pain Med
PATIENT ID LABEL
Meds
Meds
FS
FS
IV
IV
O2
O2
Foley
BM
Pain Med
Tests
Last Pain Med
Last FS
Last Pain Med
PATIENT ID LABEL
Tele
BM
Tests
Tests
Tele
Foley
BM
Pain Med
Tests
Last FS
Last Pain Med
Last FS
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VERTICAL PATIENTS BRAINSHEETS
Pt:
Age:
Rm#
Pt:
Age:
Rm#
Pt:
RN:
RN:
RN:
Dx:
Dx:
Dx:
Coverage:
FSBS:
Labs:
T
Coverage:
FSBS:
Labs:
T
KO2
Na-
Na-
KO2
RR
RR
B/P
B/P
B/P
/10
/10
PO IV
Labs:
T
KO2
Pain:
/10
/10
PO IV
Rm#
Coverage:
FSBS:
RR
Pain:
Age:
Pain:
Na-
/10
/10
PO IV
x0700
x0700
x0700
x0800
x0800
x0800
x0900
x0900
x0900
x1000
x1000
x1000
x1100
x1100
x1100
x1200
x1200
x1200
x1300
x1300
x1300
IV
IV
IV
RATE
RATE
RATE
NOTES
NOTES
NOTES
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VERTICAL PATIENTS BRAINSHEETS
Pt:
Age:
Rm#
Pt:
Age:
Rm#
Pt:
RN:
RN:
RN:
Dx:
Dx:
Dx:
Coverage:
FSBS:
Labs:
T
Coverage:
FSBS:
Labs:
T
KO2
Na-
Na-
KO2
RR
RR
B/P
B/P
B/P
/10
/10
PO IV
Labs:
T
KO2
Pain:
/10
/10
PO IV
Rm#
Coverage:
FSBS:
RR
Pain:
Age:
Pain:
Na-
/10
/10
PO IV
x0700
x0700
x0700
x0800
x0800
x0800
x0900
x0900
x0900
x1000
x1000
x1000
x1100
x1100
x1100
x1200
x1200
x1200
x1300
x1300
x1300
IV
IV
IV
RATE
RATE
RATE
NOTES
NOTES
NOTES
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FREEHAND BRAINSHEET
DX/Docs:
DX/Docs:
Neuro:
Cardio:
Neuro:
Cardio:
Resp:
GI:
Resp:
GI:
GU:
Skin:
GU:
Skin:
Orders:
Labs:
IV/ Lines:
Meds:
IV/ Lines:
Meds:
Allergies:
Diet:
Allergies:
Diet:
Code Status:
Precautions:
Code Status:
Precautions:
PMH:
Activities/ Misc:
PMH:
Activities/ Misc:
Labs:
pH:
pCO2:
pO2:
HCO3:
FiO2:
pH:
pCO2:
pO2:
HCO3:
FiO2:
Orders:
DX/Docs:
DX/Docs:
Neuro:
Cardio:
Neuro:
Cardio:
Resp:
GI:
Resp:
GI:
GU:
Skin:
GU:
Skin:
Orders:
Labs:
IV/ Lines:
Meds:
IV/ Lines:
Meds:
Allergies:
Diet:
Allergies:
Diet:
Code Status:
Precautions:
Code Status:
Precautions:
PMH:
Activities/ Misc:
PMH:
Activities/ Misc:
Labs:
pH:
pCO2:
pO2:
HCO3:
FiO2:
pH:
pCO2:
pO2:
HCO3:
FiO2:
Orders:
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POSTPARTUM BRAINSHEET
Respiratory (Air):
cough
dyspnea
rales
rhonchi
wheezes
color:
lochia:
Cardiovascular (Water):
breast engorgement
orthostatic hypot'n
petechiea
edema
vertigo
bowel sounds x
abd distention
diarrhea
hemorrhoids
last stool
n/v
constipation
flatus
GU (Elim/Hazards):
abd tone:
urine retention
dysuria
mL
IV:
MS (Activity/Normalcy):
@
cc/°;
fundal location:
uterine cramping
diastasus rectus
abdominal striae
perineal muscles
Integument (Hazards/Normalcy):
breasts:
nipples:
perineal:
clots
voiding pattern:
with assist?
bladder distention
oliguria
Fr; @
; odor:
appetite/intake:
GI (Food/Elim/Hazards):
foley:
/°; color:
Homan's Sign
disphoresis
hematomas
hemorrhoids
soft
firm
intact
dry
swelling
bruising
laceration
episiotomy
°
CNS (Social Interaction/Hazards):
LOC
tremors
pain
clonus
epidural @
DTR's
;
;
; consistency:
mobility:
pigmentation: (nipples, linea negra, striae, chloasma)
REEDA
affect:
Health Deviation:
pumping
postpartum
infant security teaching
bonding:
Developmental / Emotional:
breastfeeding consult?
need
neo. care (ch. 19)
Sex:
Apgar 1m:
recv'd
social support:
inquisitive?
5m:
Blood Type:
Wt.
Len.
Dir. Coombs:
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POSTPARTUM BRAINSHEET
Student:
Client Initials:
Date:
Room:
Diet:
Nurse:
Allergies:
Cultural Background:
Primary Language:
Date & Time of Birth:
Childbirth Prep?
Hct:
T
Hgb:
P
A
Vaginal
Feed:
Breast
Blood Type:
L
Cesarean
Bottle
Rhogam:
Needed
Rubella:
Imm
HBSAg:
Med Order
1500–1600:
Pos
Given
Non-imm
Neg
Last Given
charts; assess
1600–1700: chart vs;
1700–1800:
1800–1900:
1900–2000:
2000–2100:
2100–2130: final charting;
Input:
Vitals
Temp
HR
Output:
RR
Pain
BP
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PATIENT MEDSURG BRAINSHEET
7
Room:
O 2:
Tele:
P:
P:
P:
Accu
7
7
R:
R:
R:
: 07
S/L:
Diet:
B/P:
B/P:
B/P:
1100
9
8
11
R:
R:
R:
: 07
S/L:
Diet:
B/P:
B/P:
B/P:
1100
9
8
R:
R:
R:
: 07
1
3
2
Dx:
4
5
T:
T:
T:
2100
11
12
1
Age:
3
2
Dx:
4
5
O 2:
O 2:
O 2:
1700
7
Assessment
T:
T:
T:
2100
11
12
1
Age:
3
2
Dx:
O 2:
O 2:
O 2:
1700
4
5
6
7
Hx:
Assessment
IV:
Amb:
WBC
6
Hx:
IV:
Amb:
10
7
Assessment
O 2:
O 2:
O 2:
1700
10
6
Hx:
IV:
Amb:
Name:
S/L:
Diet:
B/P:
B/P:
B/P:
1100
12
Age:
Name:
Room:
O 2:
Tele:
P:
P:
P:
Accu
Date:
10
Name:
Room:
O 2:
Tele:
P:
P:
P:
Accu
9
8
T:
T:
T:
2100
Hgb
Hct
Plt
Na
K+
Cl
BUN
CO2
Cr
Mg
Glu
Ca PO4
PTT
PT
INR
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PATIENT MEDSURG BRAINSHEET
7
Room:
O 2:
Tele:
P:
P:
P:
Accu
7
7
R:
R:
R:
: 07
11
9
9
O 2:
O 2:
O 2:
1700
R:
R:
R:
: 07
4
5
10
Assessment
11
O 2:
O 2:
O 2:
1700
12
1
3
2
Dx:
4
5
6
7
Hx:
Assessment
T:
T:
T:
2100
11
12
1
Age:
3
2
Dx:
O 2:
O 2:
O 2:
1700
4
5
6
7
Hx:
Assessment
IV:
Amb:
WBC
7
Hx:
IV:
Amb:
10
6
T:
T:
T:
2100
Name:
S/L:
Diet:
B/P:
B/P:
B/P:
1100
3
2
Dx:
Age:
S/L:
Diet:
B/P:
B/P:
B/P:
1100
8
1
IV:
Amb:
Name:
R:
R:
R:
: 07
12
Age:
S/L:
Diet:
B/P:
B/P:
B/P:
1100
8
Room:
O 2:
Tele:
P:
P:
P:
Accu
Date:
10
Name:
Room:
O 2:
Tele:
P:
P:
P:
Accu
9
8
T:
T:
T:
2100
Hgb
Hct
Plt
Na
K+
Cl
BUN
CO2
Cr
Mg
Glu
Ca PO4
PTT
PT
INR
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POSTPARTUM MOM-BABY BRAINSHEET
BABY
NAME
TIME OF DELIVERY
PEDIATRICIAN
V
C
EPISIOTOMY: Y / N
COMPLICATIONS
MALE
G
WT:
P
ALLERGIES
BLOOD: A
FEMALE
LBS
APGARS:
O B AB
+ -
OZ
GRAMS
1MIN
GESTATION:
5MIN
WKS
DAYS
NEED RHOGAM: Y / N
BREAST / BOTTLE / BOTH
RUBELLA: IMM / NON
FEEDING? Y / N
HEP B: POS / NEG
LACTATION CONSULT: Y / N
HIV: POS / NEG
VS
0800
1200
1600
PEE: Y / N
T
POOP: Y / N
HEP B: Y / N
HEARING TEST: Y/ N
BP
BLOOD:
RR
A O B AB + -
COOMBS: NEG / POS
O2
PKU: Y / N
PAIN
B
U
B
B
L
E
H
E
VS
0800
1200
1600
T
0800
1200
RR
1600
LABS
NOTES
MEDS:
VOIDING: Y / N
IN
PASSING GAS: Y / N
OUT
MEDS
DIET
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ICU DETAILED BRAINSHEET
Rm:
Name:
Resp:
GI:
POD:
Age:
Weight:
Height:
RR:
Pulse:
O2:
Sputum:
BM:
NG/OG/PEG:
TF/DIET:
Admit:
Cardiac:
Skin/Circ:
HX:
Orders:
RBC:
Hgb:
Hct:
WBC:
Plt:
BUN:
Creat:
GFR:
Intervention:
M.D's:
K:
SCD'S:
TEDS:
HR:
BP:
Tele:
DX:
BNP:
NA:
Cl:
CO2:
GU:
ALB:
ALT:
AST:
Neuro:
BILI:
Ca:
Urine:
Inc/Drsg:
I. Ca:
PROT:
Braces:
TROP:
CK-MB:
Foley:
Temp:
Allergies:
Chems q.: 7Lines/gtts:
Voids:
11-
Meds:
16-
Pain:
Mg:
Phos:
CT:
DIG:
PT:
INR:
CVL:
Art Line:
CXR:
PTT:
UA:
COLOR:
CLAR:
GLUC:
Ppeak:
Pmean:
PEEP:
I:E
KEY:
SPGR:
BLOOD:
PH:
FTOT:
VTE:
VETOT:
ET SIZE:
*
LENGTH
:@ LIPS:
PROT:
LIPID:
CHOL:
HDL:
LDL:
TRIG:
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CHARGE NURSE BRAINSHEET
ROOM #:
ROOM #:
ROOM #:
ROOM #:
Name:
Age
Diagnosis:
ADM Date
History
Allergy
Code
FULL
Isolation
NONE
CONTACT
DROPLET
AIRBORNE
PREVENTION
DNR
NONE
CONTACT
DROPLET
AIRBORNE
PREVENTION
NONE
CONTACT
DROPLET
AIRBORNE
PREVENTION
NONE
CONTACT
DROPLET
AIRBORNE
PREVENTION
IV Access
PIV X
CL
PICC
HEMACATH
A-LINE
PIV X
CL
PICC
HEMACATH
A-LINE
PIV X
CL
PICC
HEMACATH
A-LINE
PIV X
CL
PICC
HEMACATH
A-LINE
RESP
02- RA NC
FM
BIPAP
VENT: AC Bilevel CPAP
FM
02- RA NC
BIPAP
VENT: AC Bilevel CPAP
FM
02- RA NC
BIPAP
VENT: AC Bilevel CPAP
FM
02- RA NC
BIPAP
VENT: AC Bilevel CPAP
FULL
DNR
FULL
DNR
FULL
DNR
Neuro
Cardiac/Drips
Settings:
ABG:
OG/NG/PEG
NPO
DIET
ANURIC
VOID
FOLEY
FS q
Lyte Prot
GI
GU
Labs
Skin
DVT/PUD
(circle)
Settings:
Settings:
ABG:
OG/NG/PEG
NPO
DIET
VOID
ANURIC
FOLEY
FS q
Lyte Prot
Pressure Ulcer
ABG:
OG/NG/PEG
NPO
DIET
VOID
ANURIC
FOLEY
FS q
Lyte Prot
Pressure Ulcer
Heparin/Arixtra/Lovenox
TEDS/SCDS
Protonix/Pepcid
Heparin/Arixtra/Lovenox
TEDS/SCDS
Protonix/Pepcid
1.
2.
3.
4.
1.
2.
3.
4.
Settings:
ABG:
OG/NG/PEG
NPO
DIET
VOID
ANURIC
FOLEY
FS q
Lyte Prot
Pressure Ulcer
Heparin/Arixtra/Lovenox
TEDS/SCDS
Protonix/Pepcid
Pressure Ulcer
Heparin/Arixtra/Lovenox
TEDS/SCDS
Protonix/Pepcid
Spokesman
Name
ABX
Daily Goals
1.
2.
3.
4.
1.
2.
3.
4.
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5 PATIENT VERTICAL BRAINSHEET
Room
Isolation
Room
Isolation
Room
Isolation
Room
Isolation
Room
Isolation
Patient
Patient
Patient
Patient
Patient
Diagnosis
Diagnosis
Diagnosis
Diagnosis
Diagnosis
Allergies
Allergies
Allergies
Allergies
Allergies
Code / Box / Rhythm
Code / Box / Rhythm
Code / Box / Rhythm
Code / Box / Rhythm
Code / Box / Rhythm
LOC / Activity / Fall Level
LOC / Activity / Fall Level
LOC / Activity / Fall Level
LOC / Activity / Fall Level
LOC / Activity / Fall Level
O2 / Breath Sounds
O2 / Breath Sounds
O2 / Breath Sounds
O2 / Breath Sounds
O2 / Breath Sounds
IV Site / Fluid / Rate
IV Site / Fluid / Rate
IV Site / Fluid / Rate
IV Site / Fluid / Rate
IV Site / Fluid / Rate
Diet / Accuchek
Diet / Accuchek
Diet / Accuchek
Diet / Accuchek
Diet / Accuchek
GI / GU
GI / GU
GI / GU
GI / GU
GI / GU
Abnormal Labs
Abnormal Labs
Abnormal Labs
Abnormal Labs
Abnormal Labs
Med-Pass
Med-Pass
Med-Pass
Med-Pass
Med-Pass
PRN Meds
PRN Meds
PRN Meds
PRN Meds
PRN Meds
Consults / Tests / Surgery
Consults / Tests / Surgery
Consults / Tests / Surgery
Consults / Tests / Surgery
Consults / Tests / Surgery
To Do / Collect
To Do / Collect
To Do / Collect
To Do / Collect
To Do / Collect
Notes
Notes
Notes
Notes
Notes
MD
MD
MD
MD
MD
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ICU BODY SYSTEM REPORT BRAINSHEET
DX
CODE STATUS
ISOLATION
PRECAUTIONS
MD
ALLERGIES
NEURO
WNL
sedated
paralyzed
icp
drains
WNL
ivc
stents
prn >
trach
weaning
WNL
NPO
TF
og
peg
LBM:
colostomy
TFR:
drains
NOTES
IV ACCESS
PIV
PICC
CVC
HD
DRIPS:
lantus / 70/30
RENAL
WNL
DIALYSIS
d/c foley
YES ORTHO / MOBILITY
WNL
Device:
PT/OT
SKIN / LDAs
dsg change:
limb alert
tpa
PROPHYLAXIS
pepcid
protonix
lovenox
heparin
scds
other :
PRN MEDS
TEMP:
UO:
Phos
IMAGING
SLP
WNL
Accuchek Q
insulin drip glucommander
FAMILY / POA / ADVANCE DIRECTIVES
ELECTROLYTE PROTOCOL
Ca
K
Mg
chest tubes
ENDO
PAST MEDICAL HISTORY
CULTURES
WNL
VENT
GI
BS:
ng
3% nacl drip
SERIAL LABS
PULMO
ett
heparin drip
NIHSS
CARDIO
pacer / aicd
LABS
TEMP:
UO:
UO:
TEMP:
UO:
UO:
UO:
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PATIENT VERTICAL BRAINSHEET
Rm:
Code:
Age:
Name:
Rm:
Code:
Age:
Name:
Rm:
Code:
Age:
Name:
Dr:
Dr:
Dr:
Dx:
Dx:
Dx:
Hx:
Hx:
Hx:
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
Lungs:
02:
Lungs:
02:
Lungs:
02:
Heart:
R:
Heart:
R:
Heart:
R:
Edema:
Edema:
GI:
LBM:
Edema:
GI:
LBM:
GI:
GU:
GU:
GU:
Skin:
Skin:
Skin:
Pain:
Pain:
Pain:
IV:
IV:
IV:
Diet:
Diet:
Diet:
Act:
Act:
Act:
Labs:
Labs:
Labs:
Rm:
Code:
Age:
Name:
Rm:
Code:
Age:
Name:
Rm:
LBM:
Code:
Age:
Name:
Dr:
Dr:
Dr:
Dx:
Dx:
Dx:
Hx:
Hx:
Hx:
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
Lungs:
02:
Lungs:
02:
Lungs:
02:
Heart:
R:
Heart:
R:
Heart:
R:
Edema:
GI:
Edema:
LBM:
GI:
Edema:
LBM:
GI:
GU:
GU:
GU:
Skin:
Skin:
Skin:
Pain:
Pain:
Pain:
IV:
IV:
IV:
Diet:
Diet:
Diet:
Act:
Act:
Act:
Labs:
Labs:
Labs:
LBM:
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PATIENT VERTICAL BRAINSHEET
Rm:
Code:
Age:
Name:
Rm:
Code:
Age:
Name:
Rm:
Code:
Age:
Name:
Dr:
Dr:
Dr:
Dx:
Dx:
Dx:
Hx:
Hx:
Hx:
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
Lungs:
02:
Lungs:
02:
Lungs:
02:
Heart:
R:
Heart:
R:
Heart:
R:
Edema:
Edema:
GI:
LBM:
Edema:
GI:
LBM:
GI:
GU:
GU:
GU:
Skin:
Skin:
Skin:
Pain:
Pain:
Pain:
IV:
IV:
IV:
Diet:
Diet:
Diet:
Act:
Act:
Act:
Labs:
Labs:
Labs:
Rm:
Code:
Age:
Name:
Rm:
Code:
Age:
Name:
Rm:
LBM:
Code:
Age:
Name:
Dr:
Dr:
Dr:
Dx:
Dx:
Dx:
Hx:
Hx:
Hx:
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
VS:
Wt: ______ BS:
20 ________________ 21 ______
24 ________________ 06 ______
04 ________________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
I ________
O ________
IV ________
Lungs:
02:
Lungs:
02:
Lungs:
02:
Heart:
R:
Heart:
R:
Heart:
R:
Edema:
GI:
Edema:
LBM:
GI:
Edema:
LBM:
GI:
GU:
GU:
GU:
Skin:
Skin:
Skin:
Pain:
Pain:
Pain:
IV:
IV:
IV:
Diet:
Diet:
Diet:
Act:
Act:
Act:
Labs:
Labs:
Labs:
LBM:
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PATIENT DETAILED BRAINSHEET
Dx
PMH
Neuro
AOX 3 2 1
Resp
Forgetful
Confused
LPM
NC
Voiding
GU
Foley
Routine
VS q4 ° Daily Wgt
T
BP
HR
O2
R
LS
Cards
EF
SR ST SB AF FL
RA
GI
Incont
Incont
Skin/Wound
Strict I/O
Labs
Guiaic
PTT
IV
Cath/EP Lab
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 FS
8
12
17
18
22
CK
Pho
Trop
gtts
Call MD
HR <
>
SBP<
>
DBP>
T>
RR <
>
O2 <
PTT >
R∆
Fall
Precaution
Fall Bleed ASP
Cont Air Drop
Diet
ad lib BR x
° BRP
AMB OOB to Chair c Assist x
Name & Age
Code
Allergy
Full
LC#
SL
Mag
Fent
Versed
Cont
IVF
Plans
Activity
BNP
Ca
PT/INR
Meds
Venodynes
DX
NPO
HH
2gNA
NKDA
ADA
Renal
MD
R1
DNR/I
Regular
N
CC
I/O
Rm
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ICU REPORT BRAINSHEET
DX
CODE STATUS
ISOLATION
PRECAUTIONS
MD
ALLERGIES
NEURO
WNL LABS
sedated
paralyzed
icp
drains
pacer / aicd
ivc
stents
trach
weaning
ELECTROLYTE PROTOCOL
K
Mg
Ca
chest tubes
Phos
WNL IMAGING
NPO
TF
BS:
ng
og
LBM:
TFR:
peg
colostomy drains
Accuchek Q
insulin drip glucommander
PIV
PICC
CVC
HD
DRIPS:
lantus / 70/30
WNL
RENAL
DIALYSIS
d/c foley
YES ORTHO / MOBILITY
dsg change:
tpa
limb alert
WNL PROPHYLAXIS
Device:
PT/ OT
SKIN / LDAs
pepcid
protonix
lovenox
heparin
other:
scds
PRN MEDS
TEMP:
UO:
SLP
WNL IV ACCESS
ENDO
NOTES
SERIAL LABS
WNL
VENT
GI
FAMILY / POA / ADVANCE DIRECTIVES
NIHSS
prn >
PULMO
PAST MEDICAL HISTORY
3% nacl drip
WNL CULTURES
CARDIO
ett
heparin drip
TEMP:
UO:
UO:
TEMP:
UO:
UO:
UO:
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BOX BRAINSHEET
Room #
Pt. Name:
Age:
EMV:
Sex:
Service:
Admit Date & Diagnosis:
PMH:
Attending:
Allergies:
Procedures:
Password:
ISO:
Diet:
Output:
Activity:
O2:
VS:
FS:
8
12
Telemetry:
IV:
Fluids/Drips:
17
21
Meds:
Skin:
To Do:
Pump/ Drain Totals:
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HOURLY BRAINSHEET
wt:
vs:
iso:
allergies:
admit:
History
Neuro :
Resp :
- activity
BS:
WOB:
aeration:
rate:
sats:
O2:
- pupils
- pain
tx:
CV :
- temp
access:
GI/GU :
- HR
- feeding tube
- BP
- abdomen
- p/p
- urine
- stool
Skin :
Social & Teaching :
08/20
09/21
10/22
11/23
12/00
13/01
14/02
15/03
16/04
17/05
18/06
19/07
quad
conex
allergies
IPOC
ER equipment
monitors
ID
Kardex
board
tubing
uids
bath
linens
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Di l i
i f
ti
t NRSNG
CARDIAC BRAINSHEET
Room:
Age:
PATIENT ID LABEL
Allergies:
D.C:
Dx:
Tx:
PMHx:
Pre/Post W:
Post-Op day:
Diet:
ADT: MM/DD/YYYY
GU:
Mobility:
ISO:
SED0H:
Meds
Meds (check the box)
0700 | 15/3
1100 | 19/7
0800 | 16/4
1200 | 20/8
0900 | 17/5
13/1 | 21/9
1000 | 18/6
14/2 | 22/10
PNR Meds:
WBC
Hgb
Hct
Plt
Na
Cl
BUN
K+
CO2
Cr
Glu
Mg
Ca
Ca PO4
PO4
Assess:
BCL
TP
Edema
IV
2. LOC
1. Safety
3. Check
Re-site
Bed low
O/Ax3
Chest Pain
Cough
Tubing
Bed rail
GCS
Dizziness
SOB
Bag
Call bell
PEERLA
Turgor
Radial Pulse
Allergy/ID
L
Skin Color/ T0
Suction/ O2
R
Pedal Pulse
4. Auscultation
AM
12
7
PM
L
R
Notes:
APE to Mam. Apical HR
Lungs
BS x 4
BM (last)
Flatus
Incision
Dressing
:
Site
Tele/Rhythm
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CARDIAC BRAINSHEET
Time
BP
HR
SpO2
Temp
RR
Pain
I/O
%Eaten:
D: U/BM/Y/BL
Time
SBAR Report
Fluid Restriction:
(ml)
Color/Odor/Type
I: (What)
(ml)
Time
(ml)
Orders:
1. All meals sign off
2. Three flowsheets done
Report:
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ED BRAINSHEETS
Room#/
Name
Chief Complaint
Lab work
Imaging
Medications
Done
XR-
Given:
Needs
CT-
Redraws:
Abnormal
Results
Needs:
USDone
Needs
XRCT-
Redraws:
Given:
Needs:
USDone
Needs
XRCT-
Redraws:
Given:
Needs:
USDone
Needs
XR-
Given:
CTRedraws:
Needs:
US-
Done
Needs
XR-
Given:
CTRedraws:
Needs:
US-
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ROUNDS BRAINSHEET
Room:
PATIENT ID LABEL
Date:
Chief Complaint:
Diagnosis:
MD:
Code Status:
Level of Care:
PMH:
Allergies:
Precautions:
VS:
MJ:
Required For Daily Health Care Team Rounds
Case management reports, Dx, OBS, GMLOS, RightCare
Neuro:
Cardiac:
Resp:
From:
Home/SNF
Telemetry:
Y/N
O2 Needs:
IV/access:
Rhythm:
Respiratory:
Chronic:
Y/N
IV meds:
Restraints: Y/N
GI:
GU:
Skin:
Safety/Mobility:
Diet:
Tolerating:
Y/N
Activity:
PT Eval:
Y/N
VTE proph:
Last BM:
Chronic:
Pain:
Mech/Chem/Amb 3x per day
Foley:
Y/N
Y/N
Barriers to Transitioning to Next Level of Care? Anticipated
Transition Date?
Lab Results:
Test Results:
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DETAILED BODY SYSTEM BRAINSHEET
Room #:
Level of Care: PCU/5B/ICU
Doctors/Consults
24 Hour Events
PATIENT ID LABEL
RT#
Code:
Allergy:
Dx/Scenario:
ISOL:
PMHx:
Social/Family:
Last updated:
POA:
Fall Risk:
Y/N
NEURO:
A/OX:
CAM-ICU:
+/-
MAAS:
Rounds Sequence
1. Description of Patient
SAT
Pain:
Y/N
CARDIAC:
2. Sig. Events of last 24 hrs.
Gtts:
PIV
Rhythm/HR:
CL
3. Vital Signs/
PICC
4. DVT Prophylaxis
BP:
Qtc:
T max:
PULM:
5. Oxygen Status
ART
EF:
ABG
SBT
pH
Y/N
Ventilator
MODE:
MODE:
PCO2
Pass/Fail
VT:
FiO2:
FiO2:
PS:
PO2
6. Lines
Bipap
7. Mas/Sed gtts/CAM-ICU
8. Skin/Surgical Wounds
9. Mobility Status
PEEP:
HCO3
PS:
GI:
10. Nutrition
POC:
Diet/TF:
Last BM:
BS:
07*19
08*20
GU:
I/O:
09*21
24 hr UO:
10*22
11*23
SKIN:
11. Concerns/Request
12. Safety Risk(s)
High risk med/safety
ID Band Check
Alarm Limit Checks
Bedside Assessment
Needed?
Any Questions?
12*00
Wounds:
13*01
14*02
Wound Consult:
ABS/TESTS:
Y/N
15*03
PT
16*04
PTT
Hg
17*05
Hct
INR
Plt
WBC
18*06
19*07
Na
Cl
Ica
K
CO2
Mg
Phos
BUN/Cr
glucose
Repeat Labs:
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4 PATIENT OB BRAINSHEETS
Mom
Education
Room
Name
Dr.
G
Date & Time of Delivery
Ante
Vag
CS
Blood type
Flu
P
PPS
Married
Epis/Lac
GBS
FOB
Education
Girl Name
DTV
HIV
1900 2300 0300
Allergies:
Hx:
GA
AGA
SGA
LGA
Blood type
Bath Given
Care Plan
Breast
Dr.
° Anesthesia
HepB
Baby
Boy
Age
F/C
Rubella
Tdap
Care Plan
Day
Bottle
Weight
BGMs until
NICU
24 Hr VS/CCHD/PKU due @
Circumcision
TCI
@
Vitals
Time
Temp
HR
RR
Time
Temp
HR
RR
hrs.
Additional Info:
Time
Pain Meds:
Anaprox
Feed
Void
Stool
Motrin @
Percocet @
Scheduled Meds:
Mom
Education
Room
Name
Dr.
G
Date & Time of Delivery
Ante
Vag
CS
Blood type
Flu
P
F/C
PPS
Rubella
Tdap
Care Plan
Day
Married
Epis/Lac
GBS
FOB
Allergies:
Hx:
Education
Boy
Girl Name
DTV
HIV
1900 2300 0300
GA
AGA
SGA
Blood type
Bath Given
LGA
Bottle
Weight
BGMs until
NICU
24 Hr VS/CCHD/PKU due @
Circumcision
TCI
@
Vitals
Time
Temp
HR
RR
Time
Temp
HR
RR
hrs.
Additional Info:
Time
Pain Meds:
Care Plan
Breast
Dr.
Age
° Anesthesia
HepB
Baby
Anaprox
Feed
Void
Stool
Motrin @
Percocet @
Scheduled Meds:
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4 PATIENT OB BRAINSHEETS
Mom
Education
Room
Name
Dr.
G
Date & Time of Delivery
Ante
Vag
CS
Blood type
Flu
P
PPS
Married
Epis/Lac
GBS
FOB
Education
Girl Name
DTV
HIV
1900 2300 0300
Allergies:
Hx:
GA
AGA
SGA
LGA
Blood type
Bath Given
Care Plan
Breast
Dr.
° Anesthesia
HepB
Baby
Boy
Age
F/C
Rubella
Tdap
Care Plan
Day
Bottle
Weight
BGMs until
NICU
24 Hr VS/CCHD/PKU due @
Circumcision
TCI
@
Vitals
Time
Temp
HR
RR
Time
Temp
HR
RR
hrs.
Additional Info:
Time
Pain Meds:
Anaprox
Feed
Void
Stool
Motrin @
Percocet @
Scheduled Meds:
Mom
Education
Room
Name
Dr.
G
Date & Time of Delivery
Ante
Vag
CS
Blood type
Flu
P
F/C
PPS
Rubella
Tdap
Care Plan
Day
Married
Epis/Lac
GBS
FOB
Allergies:
Hx:
Education
Boy
Girl Name
DTV
HIV
1900 2300 0300
GA
AGA
SGA
Blood type
Bath Given
LGA
Bottle
Weight
BGMs until
NICU
24 Hr VS/CCHD/PKU due @
Circumcision
TCI
@
Vitals
Time
Temp
HR
RR
Time
Temp
HR
RR
hrs.
Additional Info:
Time
Pain Meds:
Care Plan
Breast
Dr.
Age
° Anesthesia
HepB
Baby
Anaprox
Feed
Void
Stool
Motrin @
Percocet @
Scheduled Meds:
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NEURO ICU BRAINSHEET
PACU:
19:
Intake
Output
EBL
Drains Output
PATIENT ID LABEL
20:
NEURO DEFICITS
21:
22:
DRAINS
Type:
24 hr Output:
Level:
Drainage:
CSF Studies:
23:
PULMONARY
CV
IVF/Drips
Rhythm:
BP Limits:
CPV Limits:
Central Line: Y/N
Location:
Change date:
Peripheral IV: Y/N
Site/Gauge/Date Inserted:
GI
Tube Feeds: Y/N
24:
Breath Sounds:
RR:
O2 Therapy:
O2 Stats:
Tracheostomy: Y/N
01:
size:
Ventilator: Y/N
Settings:
Secretions:
Diet:
Swallow Eval?
02:
GU
Last BM:
Voids: Y/N
03:
Type/Rate:
Catheter Type:
Leg Strap on: Y/N
Dobhoff or PEG
Location:
04:
Size and Markings:
SKIN/ACTIVITY/RESTRICTIONS
PRN MEDS
LABS
PT/OT/Speech/MSW
05:
Restraint Type:
06:
Due:
07:
Accuchecks:
-Max:
AC/HS
Q6H
gtt
TO DO
ASK MD
TED/SCDs
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ICU BRAINSHEET
Room:
Patient
Diagnosis:
Comorbid Conditions\Hx:
DATE:
Age Sex
Admitted:
Procedure
Code Status:
SIGNIFICAT HOSPITAL HISTORY
HD:
LOS:
Allergies
BODY SYSTEMS
Neuro:
Neuro:
Orientation:
PLAN:
VARIANCE
Pupils:
Temp:
Weight:
Restraints
Psych/Soc
Extremity Strength
Activity
Fall Precaution:
CV:
Rhythm:
HR:
BP:
“A” Line
Swan Ganz:
PA
PAWP
CVP:
CO
Pacer Wires:
K+:
CPK:
CBC:
Hct:
PT
Mg+:
MB’s:
Trop:
HGB
PTT
Ca:
Edema (small= +1 moderate=+2 Pitting= +3)
Pulses (R) (L) (absent=0 weak=1 strong=2)
PICC/Central line/ IJ:
Hep Lock:
DRIPS:
Cardiovascular:
PLAN:
VARIANCE
cc/hr
PUL:
Extub:
RR:
BS:
Coughing
Chest Tubes:
ABG:
Pressure
O2
Sputum
Bipap:
Mode:
Respiratory
PLAN:
VARIANCE
Mask:
Tri ow
Cu
FiO2
TV rate
GI
BS
NG
Diet:
Feeding
Chemstrip:
GU
Foley:
Urine Output:
Abd Contour
Flatus:
pH:
BM
Appetite:
Cath Care:
PD
Hemo
SG
GI:
PLAN:
VARIANCE
GU:
I&O’s
PLAN:
VARIANCE
Skin/dressing/incisions:
Specimens:
Braden Scale:
Test, Labs
Procedures, hx, preps
Other:
Other:
Discharge Plan:
Teaching/learning:
Consults:
Variance to Discharge Plan: Barrier
Resolution:
Consults:
Special Needs:
Ca
PTT
CPK
CKMB%
Mg
PT
CKMB
TROP
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BOXES BRAINSHEET
Name:
Code Status:
MD:
Age:
Room:
Diagnostic Symptoms Personal Family
Activity
Vent
Neuro
Cardio
Resp
History
Skin
Urinary
GI
Nutrition
Labs
Na
K
Wbc
IV
CL
CO2
hgb
Hct
Education
BUN
CR
plts
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BOXES BRAINSHEET
Tests
POC
Meds
Core
Measures/VTE
1800
2200
0200
1900
2300
0300
V/S:
V/S:
V/S:
2000
0000
0400
2100
0100
0500
In
Out
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SIMPLIFIED BRAINSHEET
To Do:
N:
CV:
R:
GI:
Labs needed:
GU:
Sk:
IV:
Dx:
Pain:
Cons:
VS:
Plan:
Accu:
I:
Labs:
Report:
O:
Dem:
All:
Adm, c/c:
PMHx:
Plan:
Systems:
IV:
Rx:
Labs:
Pending:
Issues:
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WHITESPACE BRAINSHEET
Rm:
Name:
CODE:
DONE:
In
Out
VS
Med
Mar
IV
Post
Pt.
Strip
Labs
Tape
IV Fluids
Re-check
NaCl
Hep
NTG
Protocols
Time
Value
Replace
Re-check
MAR Times
Glucs
K+
0700
Mg
1200
Heparin
1700
NOC
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MEDSURG BRAINSHEET
RM#
PT:
age:
M / F Code:
Diet:
DX:
HX
Allergies:
Neuro AOX 1 2 3 Confused
GI
Forgetful
Incont
UG
I/O
Foley
Voiding
Incont
Activity
Resp
VS
T
Skin/Wound
BP
HR
O2
R
Meds
Labs
Precautions: contact / fall / seizure /
IV/Lines
aspiration (HOB
Diabetic Mgmt
°) / neuro
Consult/Appts
Insulin
accu
SS
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PATIENT CIRCLE BRAINSHEET
RM#
PT:
age:
DX:
M / F Dr.
diet:
d/weight
Allergies:
O2 :
nebs
activity:
ad lib / bed rest / in chair / PT / walker / assist x
IV fluids:
DNR
PCA (dem / morph)
access:
pain meds (last dose?):
voids: BRP / foley / BSC / urinal / diaper
UA / C&S (need / done)
stool x
SNF / rehab consult (need /done)
for guiac / c-diff / WBC
precautions: contact / fall / seizure / aspiration (HOB
FSBS: ac&hs / q
2100:
°) / neuro
hrs / SS: regular insulin / Novolog
0730:
1130:
1630:
labs: CBC / MP / CE / BNP / Mag / Phos / K / Lytes / H&H / PT/INR / PTT /
CXR / EKG / Echo / MRI / US / CT
permit? Y / N
VS 0600 T
P
R
BP
O2
T
P
R
BP
O2
list? Y / N
Notes:
Hx :
Labs:
Na:
K:
BUN:
Creat:
WBC:
H/H:
Plat:
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SBAR BRAINSHEET
S
Patient name
Room number
allergies
Age
Admit date
1 Dx
Attending
Code status
2 Dx
Pgr/#
History
Isolation
Core Measures
Surgery:
Restraints
CHF MI PNA
Surgeon
Anesthesia
A
Consultants
Advanced directive on
chart?
C/O
B
Physician
Anesthesiologist
Fall risk
EBL
Vaccine- PNA Flu
Cardiac: BP/HR/Peripheral pulses/Edema/Heart sounds
Pain/sedation
Current rhythm
Pain scale
Daily wt?
Location
Meds type and last dose
DVT prophylaxis
Pulmonary: Breath sounds/Secretions/ SpO2/UPAs/PIP/
Spontaneous VT & VE
Vent/bipap etc
Accu checks
settings
Frequency
A1C
Last Results
GI
NG/OGT
BS
Diet
Prophylaxis
Last BM
Skin
Wounds/Drainage
GI
Staples
Drains
GU Foley/void
Location
Output
Ducub photo on admission
IV
Date inserted
Fluids
Gtts
Psych Social
Meds
Pending orders
Na
Cl
Bun
gluc
mg
BNP
K
Co
Cr
Ca
Phos
DDimer
Coags
INR
Cardiac enz
R
1
2
DC Plan. Is pt informed of plan
3
Hct
UA
CXR
W
Pl
Cultures
PTT
Next lab
24 hour orders reviewed
CT
MRI
Echo
Hgb
Shift goals
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MEDS-LABS-VITALS BRAINSHEET
Date:
Phone#
Room #
Age:
DX:
Diet:
TIME:
T
P
R
BP
POX
Voice Care?
Name:
DR:
MEDS:
Charted ?
Code Status:
Allergies:
Activity:
02:
HT/WT:
IV:
07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 00 01 02 03 04 05 06
TIME:
T
P
R
BP
POX
HX
TIME:
T
P
R
BP
POX
IN:
OUT:
Monitor Reports:
7-3
3-11
11-7
REPORT
A&O____ Confused
AP Reg Irreg
Lungs: clear decreased rhonchi
insp exspir wheezes
abd soft nontender distended
BSX4 hyper hypo
+PP edema - 0 1 2 3 4 LE UE
Pain
Foley
ASSESS
A&O
Confused
AP Reg Irreg
Lungs: clear decreased rhonchi
insp exspir wheezes
abd soft nontender distended
BSX4 hyper hypo
+PP edema - 0 1 2 3 4 LE UE
Pain
Foley
TESTS/RESULTS
Glucometer:
Break:
Lunch:
Dinner:
H.S.:
Plans for the
Shift:
Yesterday
RBC
WBC
HGB
HCT
PLTS
PT
INR
PTT
BUN
CREAT
Na+
K+
Mag+
Ca++
DIG
BNP
Today
(4.2-5.4)
(4.8-10.8)
(M14-18)(F12-16)
(M42-52)(F37-47)
(150-400)
(9.3-11.8)
(0.0-3.5)
(23-33.4)
(M9-21)(F7-18)
(M0.8-1.2)(F.7-1.2)
(135-145)
(3.5-5.5)
(1.8-2.4)
(8.5-10.5)
(0.9-2.0)
(0-100)
NEW ORDERS
Troponin
Enzymes:
+
-
1 2 3
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ICU BOX BRAINSHEET
NAME
Wt:
DOB
Rm#
Admit Date
ISO:
CODE:
PMD:
1900
Consults:
_____________________
2000
ALLERGIES
_____________________
2100
Diagnosis
Medical Hx
Procedure/Surgery
_____________________
2200
POD#
BP
Diet
_____________________
2300
LABS
P
_____________________
0000
RR
IV
_____________________
0100
T
SpO
2
NEURO
RESP O2:
Vent Settings:
Tx:
_____________________
0200
CARDIAC Tele/Rhythm
Pacemaker
_____________________
0300
_____________________
0400
SKIN
GI/GU
MUSC
Activity
_____________________
0500
_____________________
0600
_____________________
0700
Orders/Plan:
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