| Assessment / Intervention | Day 1 | Day 2 | Day 3 (Blank) |
|---|---|---|---|
| Vitals | |||
| Blood Pressure (###/## mmHg) | |||
| Temperature (F/C) |
.
|
.
|
.
|
| Heart Rate (bpm) | |||
| Resp Rate (rpm) | |||
| O2 Saturation (%) | |||
| Neuro Assessment | |||
| LOC / Orientation | |||
| Cardiovascular | |||
| Heart Rhythm | |||
| Respiratory | |||
| Breath Sounds | |||
| GI | |||
| Abdominal Assessment | |||
| GU | |||
| Voiding / Catheter | |||
| Skin | |||
| Skin Integrity | |||
| Pain Assessment | |||
| Pain Score (0-10) | |||
| Miscellaneous | |||
| Additional Notes | |||