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Joseph A. Guevarra Name of Hospital offering IV Training: PLTCI-Luis A. Tiam Medical Center Date of IV Training Program Attended: March 6 -8, 2013 I. Patient no. 001 002 003 Initiating/ maintaining Peripheral IV Infusions Name of Age Date Time patient Liam Baltazar Judy Dulinayan Redencio Valdez 4 33 28 04-05-13 04-05-13 04-05-13 7:05pm 6:35pm 4:40pm Kind of infusion PLRS D5LR PNSS Site Left Metacarpal Vein Right Metacarpal Vein Left Metacarpal Vein Type of cannula G24 G22 G22 Dose L 1L 1L PRC Number: 0792834 Provider no. : 168 Venue: PLT Wellness Resort Function Hall rate 55-66 ggts/min Mark John B. Ildefonso, RN 41-42 ggts/min Mark John B. Ildefonso, RN 41-42 ggts/min Mark John B. Ildefonso, RN 09-0099562 09-0099562 09-0099562 Signature over printed name of Certified Trainer/ Preceptor/ M.D., RN License no.
Administering intravenous Drugs Name of patient Age Date Teodoro Torio Daphne Balagan Lolita Sapon 34 1 46 04-05-13 04-05-13 04-05-13
dose 80mg IV every 6 hour 250mg IV every 6 hour 1gm IV every 8 hour
Signature over printed name of Certified Trainer/ Preceptor/ M.D., RN Mark John B. Ildefonso, RN
Licenser no.
Administering and Maintaining Blood and Blood components (2 Nurses In One Blood Transfusion Administration) Name of Age Date Time Volume/ Blood type/ IV insertion Type of diagnosis patient components/ rate cannula Lolita Sapon 46 04-05-13 7:40-7:50pm 100CC/ O positive/ FFP/ Fast Drip Brachial Veincutdown G20 CAP/Anemic/Acute lymphoblastic Leukemia
Signature over printed name of Certified Trainer/ Preceptor/ M.D., RN Mark John B. Ildefonso, RN
Licenser no.
09-0099562