HJERTECENTER VARDE

                                                                                                           JUNI   2011 

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Navn:                                                                        CPR nr.:                                                  

Adresse:                                                                   Tlf.:                                                          

Pårørende:                                                               Pårørende tlf.:                                         

Ferieadresse:                                                            Mobil:                                                      

Stamsygehus:                                                            Tlf.:                                                            

Diagnose:                                                                     Allergi:                                                    

Aktuelle tilstand

 

Fysisk:                                                                                                                                            

Psykisk                                                                                                                                           

Socialt:                                                                                                                                           

 

 

 

Blodprøver

Hæmoglobin / Kalium:                                                  

 S-Creatinin/Carbamid:                                                                                                                                                               

MRSA-podningsvar:                                                     

HIV(max 6mdr.):                                    

HCV-antistof(max 3mdr.)                                            

 Hbs-antigen(max.3 mdr.):                        

 

Værdier

 

Væske pr os:                                                                  

Diæt:                                                       

Idealvægt/tørvægt:                                                        

Slutvægt:                                                 

Start BT/puls:                                                                

Slut BT/puls:                                           

 

Dialyse

 Dialysatortype:Standard:   Hi-Flux                              

Dialysevarighed: Timer x                        

Dialysator overflade:                                                     

Ultrafiltration.                                            (Max.væsketræk pr.dialyse)

Karadgang:                                                                   

Kateter / Fistel:                                                              

Venstre:                   Højre:                      

Kanyler:                                                                         

Blodflow:                                                

 

Heparinforslag:                                                              

 Acetat/ Bikarbonatdialyse ( Total konduktivitet):                                                                         

Dialyseønsker:                                                               

 Antal:                          Uge:                      

 Formiddag:             Eftermiddag:                                 

 

Evt. komplikationer under dialyse og behandling ( kramper, BT-fald, fistelproblemer, P.N

Medicin):                                                                                                                                         

                                                                                                                                                         

                                                                                                                                                        

                                                                                                                                                       

 

Medicin:

Under feriedialyse  skal man selv medbringe sin vanlige medicin samt medicin som skal gives under dialyse: Epo, Jern, D-vitamin eller andet. Dialysekatetre lukkes som standard med Heparinlås. Benyttes der taurolock, Citralock eller andet medbringes dette.

                                                                                                                                                     

                                                                                                                                                          

 

Dato : Sygeplejerske/ Afdeling: