3+3+1 ACCOMPLISHED REQUIREMENTS of 3 DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES Name of Registered Nurse: Mayla

Arnie A. Valmonte Name of Hospital offering IV Training: Eduardo L. Joson Memorial Hospital Date of IV Training Program Attended: March 1-3, 2013
I. Initiating/Maintaining Peripheral IV Infusions Patient No. Name of Patient Age Date Time

PRC Number:0691782 Provider Number: 220 Venue: MCHC, JICA Bldg. ELJ Compound

Kind of Infusion

Site

Type of Cannula

Dose

Rate

Signature Over Printed Name of Certified Trainer/Preceptor/M.D., RN ANALINA V. TABIOS, RN

License No.

1025 1276 1377

Mary Ann Reputente Gemma D. Mendoza Nicanor Pascual

24 48 46

3/6/13 3/6/13 3/8/13

7:25 am 10:20 am 9:40 am

D5 LRS D5 LRS D5 NSS

Right cephalic vein Left cephalic vein Left metacarpal vein

Avocat G-20 Avocat G-20 Avocat G-20

1L 1L 1L

41-42GTTS/MIN 08-008148 08-008148 08-008148 41-42GTTS/MIN ANALINA V. TABIOS, RN 27-28GTTS/MIN ANALINA V. TABIOS, RN

II. Administering Intravenous Drugs Patient No. Name of Patient Age 1181 1248 1276 Alfred R. Beley Barbara G. Venturina Gemma D. Mendoza 15 32 48

Date 3/5/13 3/5/13 3/7/13

Time 11:00 am 11:30 am 8:00 am

Drug Incorporated Cloxacillin Chloramphenicol Tramadol

Dose 500 mg 1g 25 mg

Diagnosis Abscess Right Foot

Signature Over Printed Name of Certified Trainer/Preceptor/M.D.,RN

License No.

ANALINA V. TABIOS, RN G4 P3 LCCS ANALINA V. TABIOS, RN Cholecystitis ANALINA V. TABIOS, RN III. Administering and Maintaining Blood and Blood Components (2 NURSES IN ONE BLOOD TRANSFUSION ADMINISTRATION) Patient No. Name of Patient Age Date Time Volume/Blood IV insertion Type of type/Components/Rate Cannula 1182 Dessery S. Asuncion 25 3/6/13 5:30 pm 450/Type O/ PRBC/30GTTS/MIN. Right metacarpal vein Avocat G18

08-008148 08-008148 08-008148

Diagnosis

Signature Over Printed Name of Certified Trainer/Preceptor/M.D., RN ANALINA V. TABIOS, RN

License No.

Normal Spontaneous Delivery

08-008148

Submitted by: Mayla Arnie A. Valmonte Signature over Printed Name

Date Submitted: March 11, 2013

Received by: ______________________

Approved by: Alexander P. Malubag, RN Director of Nursing Service

3+3+1 ACCOMPLISHED REQUIREMENTS of 3 DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES Name of Registered Nurse: Ma. Marietta P. Cunanan Name of Hospital offering IV Training: Eduardo L. Joson Memorial Hospital Date of IV Training Program Attended: March 1-3, 2013
I. Initiating/Maintaining Peripheral IV Infusions Patient No. Name of Patient Age Date

PRC Number: On Process Provider Number: 220 Venue: MCHC, JICA Bldg. ELJ Compound

Time

Kind of Infusion D5LRS D5LRS D5LRS

Site

Type of Cannula

Dose

Rate

Signature Over Printed Name of Certified Trainer/Preceptor/M.D., RN Mylene G. Corpus, RN Mylene G. Corpus, RN Mylene G. Corpus, RN

License No.

13984 131055 131055

Gelene Villanueva Mark Anthony Cajucom Nica Cuaresma

22 19 13

3/8/13 3/8/13 3/8/13

3:30pm 10:15am 2:10pm

Right Metacarpal vein Left Metacarpal vein Left metarcapal vein

Avocat gauge 20 Avocat gauge 20 Avocat gauge 22

1 liter 1 Liter 1 Liter

4142gtts/min 4142gtts/min 4142gtts/min

12-000249 12-000249 12-000249

II.

Administering Intravenous Drugs Patient No. Name of Patient Age 1266 1266 1276 Julia Alpuerto Julia Gemma Mendoza 22 22 48

Date 3/7/13 3/7/13 3/7/13

Time 8am 8am 12nn

Drug Incorporated Ketorolac Ceftriaxone Diclofenac

Dose 30mg 2g 75mg

Diagnosis Fracture Closed Complete m/3 Femur left rd Fracture Closed Complete m/3 Femur left Chronic Calculus Cholecystits
rd

Signature Over Printed Name of Certified Trainer/Preceptor/M.D., RN Mylene G. Corpus, RN Mylene G. Corpus, RN Mylene G. Corpus, RN

License No.

12-000249 12-000249 12-000249

III.

Administering and Maintaining Blood and Blood Components (2 NURSES IN ONE BLOOD TRANSFUSION ADMINISTRATION) Patient No. Name of Patient Age Date Time Volume/Blood IV insertion Type of Cannula type/Components/Rate 1188 Dessery Asuncion 25 3/6/13 9:30pm 450/Type O/PRBC/30gtts/min Right metarcapal vein Introcan gauge 18

Diagnosis

Signature Over Printed Name of Certified Trainer/Preceptor/M.D., RN Mylene G. Corpus, RN

License No.

Normal Spontaneous Delivery

12-000249

Submitted by: Ma. Marietta P. Cunanan Signature over Printed Name

Date Submitted:March 11, 2013

Received by: ______________________

Approved by: Alexander P. Malubag, RN Director of Nursing Service

3+3+1 ACCOMPLISHED REQUIREMENTS of 3 DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES Name of Registered Nurse: Charity Christine T. Tan Name of Hospital offering IV Training: Eduardo L. Joson Memorial Hospital Date of IV Training Program Attended: March 1-3, 2013
I. Initiating/Maintaining Peripheral IV Infusions Patient No. Name of Patient Age Date

PRC Number: 0738249 Provider Number: 220 Venue: MCHC, JICA Bldg. ELJ Compound

Time

Kind of Infusion

Site

Type of Cannula

Dose

Rate

Signature Over Printed Name of Certified Trainer/Preceptor/M.D., RN Ricardo T. Ballesteros, Jr.

License No.

1275 139830 131009

Renzo Maliwat Hernando L. Eugenio Gaudencio Eusebio

17 69 51

3/6/13 3/8/13 3/8/13

10:40am 10:25am 1:30 pm

D5 LRS D5 LRS D5 LRS

Right metacarpal vein Right cephalic vein Right metacarpal vein

Avocat G-18 Avocat G-20 Avocat G-20

1 Liter 1 Liter 1 Liter

41-42gtts/min 08-022273 08-022273 08-022273 10gtts/min Ricardo T. Ballesteros, Jr. 41-42gtts/min Ricardo T. Ballesteros, Jr.

II. Administering Intravenous Drugs Patient No. Name of Patient Age 1256 1285 1275 Rosemarie Masaquit Evangeline G. Joson Renzo Maliwat 17 31 17

Date 3/5/13 3/7/13 3/7/13

Time 11:15am 8:00am 12:00nn

Drug Incorporated Hyoscine N-Butyl bromide Cefazolin Tramadol

Dose 2 amps 1g 25 mg

Diagnosis G1 P1 LCCS

Signature Over Printed Name of Certified Trainer/Preceptor/M.D., RN Ricardo T. Ballesteros, Jr.

License No.

08-022273 08-022273 08-022273

Hemorrhoids Ricardo T. Ballesteros, Jr. Bakers Cyst Right Ricardo T. Ballesteros, Jr.

III. Administering and Maintaining Blood and Blood Components (2 NURSES IN ONE BLOOD TRANSFUSION ADMINISTRATION) Patient No. Name of Patient Age Date Time Volume/Blood IV insertion Type of Cannula type/Components/Rate

Diagnosis

Signature Over Printed Name of Certified Trainer/Preceptor/M.D., RN Ricardo T. Ballesteros, Jr.

License No.

1182

Dessery S. Asuncion

25

3/6/13

5:30 pm

450/Type O/ PRBC/30GTTS/MIN.

Right metacarpal vein

Avocat G-18

Normal Spontaneous Delivery

08-022273

Submitted by: Charity Christine T. Tan Signature over Printed Name

Date Submitted: March 11, 2013

Received by: ______________________

Approved by: Alexander P. Malubag, RN Director of Nursing Service