I am caring for Tess Adams, a 36 year old female, admitted for surgical removal of Right breast (mastectomy).

   I need help in Completing the intake sheet using the following patient information.

I am caring for Tess Adams, a 36 year old female, admitted for surgical removal of Right breast (mastectomy). She is 1 day post-op with no apparent complications. She has a wound drain in place that is collecting fluid draining from her incision. She is awake and alert. She has an order for a regular diet. She is able to use the bathroom with assist. She is on strict intake and output measurements. 

My12 hour shift started at 7am. The totals from the night shift have been documented and the wound drain is empty.

1.     2:15pm – Snack  6 oz pudding and vanilla cookies 

2.    3pm – Wound drain emptied for 25 mL of serosanguinous drainage 

3.    4:30pm – voided 180 mL clear yellow urine in hat placed in the toilet 

4.     5pm – Dinner 8 oz. tomato soup, 1 roasted chicken breast,  ½ c mashed potatoes, 6 oz. broccoli spears, 1 dinner roll, 1/2 of 6 oz. container apple juice, ½ of 1 cup black coffee 

5.     6pm -wound drain emptied for 8 mL of blood tinged output

 

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I am caring for Tess Adams, a 36 year old female, admitted for surgical removal of Right breast (mastectomy). was first posted on August 10, 2020 at 4:56 am.
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