IV THERAPY ACCOMPLISHED REQUIREMENTS

Davao Medical Center Venue: Davao Medical Center

Name of Hospital Offering IV Training Province/Region: Region XI
ANSAP Chapter:
J.P. Laurel Avenue, Davao City
Address

Accomplished Requirements of:

Name of Registered Nurse: MALNEGRO. DEBORAH SORILLA PRC No.: 0485817 Expiry Date: May 14, 2011
Date of IV Training Program Attended: November 7-9, 2008 IV Requirements: 6+6+2
Registration No. of Institution Offering the IV Training: 006505

Program Kind of IV Infusion Signature of Witness M.D./ IV Trained

Age Date/ Time/ Site of IV Insertion/ Type of Cannula/ Dose/ Rate/Drug Incorporation Present
Name of Patient Given Proceptor
I. Initiating Maintaining Peripheral IV Infusions

1. ANDRADE, Grace 18 y.o. D5LR 1L Nov. 13, 2008/9:45p.m./Left Metacarpal Vein/G.18/K.V.O.

2. LARISMA, Rudita 37 y.o. D5W 500cc Nov. 17, 2008/8:45p.m./Left Metacarpal Vein/G.18/K.V.O.
3. GIROY, Maria Fe 23 y.o. D5LR 1L Nov. 17, 2008/9:10p.m./Left Metacarpal Vein/G.18/K.V.O.
4. VERIDIANO, Abegail 25 y.o. D5LR 1L Nov. 17, 2008/9:45p.m./Right Cephalic Vein/G.18/K.V.O.
5. SUMAMPONG, Angel 40 y.o. D5LR 1L Nov. 17, 2008/10:20p.m./Right Metacarpal Vein/G.18/K.V.O.
6. SANAMA, Madjah 20 y.o. D5LR 1L Nov. 17, 2008/10:45p.m./Right Metacarpal Vein/G.18/K.V.O.

II. Administering IV Drugs Date/ Time/ Drug Incorporated/ Dose/ Diagnosis

18 y.o. D5LR 1L Nov. 19, 2008/9:00p.m./Cefazolin 1gm IVTTq8/ t/c Abscess formation, back area;s/p posterior
1. MELENDREZ, Eduardo
instrumentation with pedicle screws
2. JULIAN, Wendelina 49 y.o. D5NSS 1L Nov. 19, 2008/9:10p.m./ Tramadol 25mg IVTT q8/ DM, Diabetic Foot, Wagner V (L)
29 y.o. D5LR 1L Nov. 19, 2008/9:30p.m./ Cefoxitin 1g IVTT q8/ Fracture Closed, Displaced, transverse, D/3 Radius (L); with
3. KASIM, Ibrahim
Fracture closed, displaced, comminuted
31 y.o. PNSS 1L Nov. 19, 2008/9:45p.m./ Gentamycin 80mg IVTT q8/ Open fracture; Montaggia, ® with anterior dislocation
4. MURILLO, Enocelecio
on ® elbow joint; fracture closed humerus, m/3rd (L)
5. SALIBAY, Porferia 74 y.o. D5LR 1L Nov. 19, 2008/10:00p.m./ Cefuroxime 750mg IVTT q8/ Renal cyst ®; Bosniak 2F
6. ALVARADO, Rogelio Jr. 36 y.o. D5LR 1L Nov. 19, 2008/10:15p.m./ Ketoprofen 100mg with PNSS in 10cc Slow IVTT q8/ Staghorn Calculi ®; s/p DS
III. Administering & Maintaining Blood & Blood Components

Blood Type/ Volume/

Components Date/ Time/ Site of IV Insertions/ Type of Cannula/ Rate
1. SANTOS, Merlyn 43 y.o. Type O+/ 450cc/ PRBC Nov. 20, 2008/5:45./Right Cephalic Vein/G.18/13 gtts/min
2. ROSETE, Susana 63 y.o. Type O+/ 450cc/ PRBC Nov. 17, 2008/8:45p.m./Left Cephalic Vein/G.18/12 gtts/min

This is to certify that I had successfully performed the above requirements, as countersigned by my witnesses.

Received by: ___________________________________________________________________ Submitted by: __________________________________________________________

ANSAP Signature over Printed Name of RN
IV Therapy Certification Card No.__________________________________________________ Approved by: __________________________________________________________
 Director, Nursing Service
Issued by: _____________________________________ Date: ___________________________