MPI - MEDICAL CENTER MUNTINLUPA

#38 National Road Putatan Muntinlupa City

Accomplished Requirements Name of Registered Nurse: Date of IV Training Program Attended: Registration No. of Institution Offering the IV Training Program: Name of Patient Age

Participant : Basic _6+6+2 Advance:_3+3+2

MARK PAUL D. TABING AUGUST 24 26, 2009 017

Date/Time/Site of IV insertion/Type of Cannula/Dose/Rate/Drug/ Incorporated Present

PRC No. of Participant: 574091 PRC Reg. Valid Until: APRIL 2012

Kind of IV infusion given

Signature of Witness: MD/Supervisor/HN/CN Trained as IV Nurses

I. INITIATING & MAINTAINING PERIPHERAL IV INFUSION

1. BERNABE, ARIANNE 2. VALENZUELA, MARY ANN 3. SANTOS, EMELITA 4. CHAVEZ, JOHN 5. NAPIL, MARY ANN 6. ALVIAR, MELBA
II. ADMINISTERING IV DRUGS Name of Patient

20 59 64 19 21 62

D5LR 1L X 80 PNSS 1L X 120 PLR 500cc X0 D5LR X 80 D5LR X 80 PNSS 1L X 120

9-1-09/6:30 AM/Right Metacarpal Vein/ Insyte G20/ 3132 gtts/min 9-1-09/7:50 AM/ Left Metacarpal Vein/ Insyte G22/ 20-21 gtts/min 9-1-09/9:15 AM /Left Metacarpal Vein/ Insyte G22/ 20-21 gtts/min 9-1-09/11:05 AM/Right Metacarpal Vein/ Insyte G22/ 3132gtts/min 9-1-09/ 1:10 PM/Left Metacarpal Vein/ Insyte G18/ 31-32 gtts/min 9-1-09/ 1:35 PM/Left Metacarpal Vein/ Insyte G22/ 20-21 gtts/min
Signature of Witness: MD/Supervisor/HN/CN Trained as IV Nurses

Age

Drug Incorporated/Dose

Date/Time/Diagnosis

1. GOGOLA, ARVIN 2. RIVERA, JOHN THOMAS 3. CO CHIONG, EDUARDO 4. PADILLA, ANGELITO 5. ALINDOGAN, ORO 6. ANTIQUERA, ROEL

22 20 43 50 66 33

DEXAMETHASONE (Decadron) 8mg IV RANITIDINE (Zantac) 50 mg IV METRONIDAZOLE (Flagyl) 500 mg IV BUSCOPAN (Hyoscine) 1gm IV CEFUROXIME (Zefur) 750 mg IV CEFOXITIN (Monowel) 1gm IV

9-1-09/ 8:00 AM/ PI 20 To Alleged Mauling 9-1-09/ 8:05 AM/ Close Head Injury 20 to VA 9-1-09/ 8:10AM/ UTI T/C Acute Appendicitis 9-1-09/ 10:00 AM/ T/C Urolithiasis 9-1-09/ 10:05 AM/ Diabetic Abscess Left Foot 9-1-09/12:00 PM/ CAP Moderate Risk
Signature of Witness: MD/Supervisor/HN/CN Trained as IV Nurses

III. ADMINISTERING & MAINTAINING BLOOD AND BLOOD COMPONENTS Name of Patient Age Blood Type/ Volume/ Components Date/Time/Site of IV insertion/Type of Cannula/Rate

1. LUISITO, BUENDIA 1. LUISITO, BUENDIA

53 53

O(+) / 250 cc/ PRBC O(+) / 350 cc/ PRBC

09-08-09/ 2:00PM/Left Metacarpal Vein/G18/ 15-16 gtts/min 09-08-09/ 8:45PM/Left Metacarpal Vein/G18/ 21-22 gtts/min

This is to certify that I had successfully performed the above requirements, as countersigned by witness. Received by: ANSAP IV Therapy Certification Card No: Issued by: Date:

Submitted by: MARK PAUL D. TABING, R.N.__ Signature Over Printed Name of RN Approved By: RENEE V. MALVAS, R.N., M.A.N. Director, Nursing Service Date Submitted: