Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

Area of Rotation: Station 2B

Shift: AM Shift

ATTENDANCE SHEET

Name

Time in

Signature

1. Arabelo, Stephanie
2. Dela Torre, Daniel
Leandro
3. Salud, Lovely Kim

Absent:

Late:

STUDENTS ATTENDANCE SHEET

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

Name

Time in

Absent:

Area of Rotation: Station 2B

Shift: AM Shift

Signature

Late:
BREAK SHEET

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

Name

Tim
e
out

Tim
e in

Endorsed to

Area of Rotation: Station 2B

Shift: AM Shift

Signature

1. Arabelo,
Stephanie
2. dela Torre,
Daniel
Leandro
3. Salud,
Lovely Kim

STUDENTS BREAK SHEET

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Area of Rotation: Station 2B

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

Name

Time
out

Time
in

Shift: AM Shift

Endorsed to

Signature

STUDENT ASSIGNMENT

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

Name

Area of Rotation: Station 2B

Shift: AM Shift

Assigned Students

1. Arabelo, Stephanie

2. Dela Torre, Daniel

Leandro

3. Salud, Lovely Kim

PATIENT ASSIGNMENT

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

Name of Student

Area of Rotation: Station 2B

Shift: AM Shift

Name of Patient(s)

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Area of Rotation: Station 2B

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

Shift: AM Shift

STUDENTS REQUIREMENT CHECKLIST

WEEK ____
NAMES

DAY 1
LRU

GO

SO

DPA

AX TOOL

PATHO

DAY 2
NCP

DS

DP

LFD

LRU

SO

DPA

LFD

WE

PCI E.

Journal

STUDENTS PARAPHERNALIA CHECKLIST

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

WEEK: ___
PARAPHERNALI
A

Area of Rotation: Station 2B

Shift: AM Shift

Day 1

Day 2

NAMES

NAMES

PATIENT CENSUS

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Area of Rotation: Station 2B

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

Room
No.

Patients Name

Age

Gender

Diagnosis

Shift: AM Shift

CC

A.P.

Date of
Admission

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Area of Rotation: Station 2B

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

Shift: AM Shift

MONITORING SHEET
Room
No.

Patients Name

Diagnosis

Diet

IVF
Time

VS
Level

PR

RP

Intake
BP

O2
Sat

Parenteral

Output
Stool

Time

Level

PR

RP

BP

O2
Sat

Parenteral

Output
Stool

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

Area of Rotation: Station 2B

Shift: AM Shift

MEDICATION SHEET

Student
Assigned

Roo
m
No.

Patients
Name
Name of Drugs

Day 1: Monday
Date: _______
Timing
Dosag
e

Route

Note
s

Day 2: Tuesday
Date: _______
Name of Drugs Timin Dosag
g
e

Rout
e

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Note
s

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN, MAN

Area of Rotation: Station 2B

Shift: AM Shift

TREATMENT SHEET

Student
Assigned

Room No.

Patients Name

Treatment

Prepared by:
Arabelo, Stephanie
Dela Torre, Daniel
Salud, Kim
Jan. 16, 2015

Xavier University- Ateneo de Cagayan

College of Nursing
A.Y. 2014-2015

Area of Rotation: Practicing Clinical Instructor

Date: _________________
Area of Rotation:
Station 2B
MAN

Shadowed Clinical Instructor: Mrs. Florence Baluran, RN,

Shift: AM Shift

WALA NI LABOT

Prepared

Arabelo,

Dela Torr

Salud, Ki
Jan. 16, 2