ICU / CRITICAL CARE NURSING BRAIN SHEET
★ INTENSIVE CARE UNIT PATIENT CARE TEMPLATE ★ PAGE 1 OF 2
Pg 1/2
SHIFT INFORMATION
DATE: SHIFT: ■ Days ■ Eves ■ Nights NURSE: UNIT / BED #:
PATIENT INFORMATION
ROOM / BED: PATIENT NAME: DOB / AGE: MRN: ATTENDING / FELLOW: CODE STATUS:
ALERTS & PRECAUTIONS
■ NKDA ALLERGIES: ■ FALL RISK ■ DNR/DNI ■ DNI ONLY ■ FULL CODE ■ CONTACT ■ DROPLET ■ AIRBORNE ■ MRSA ■ C-DIFF ■ VRE
DIAGNOSIS / REASON FOR ADMISSION / PMH / SURGICAL HX
VITALS (Each Assessment Time) INTAKE & OUTPUT (Hourly / Running Totals)
TIME HR BP / MAP RR SpO2 Temp Pain INTAKE OUTPUT
0000 SOURCE / TYPE AMT (mL) TIME SOURCE / TYPE AMT (mL) TIME
0200 PO / Oral Urine
0400 IV Fluids — Maint Foley / Drain
IV Fluids — Bolus Chest Tube
0600
Blood / FFP / Plts Emesis / NG
0800
TPN / Tube Feed Wound / Ostomy
1000
Medications (IV) Dialysis UF
1200
Other Other
1400
Hourly UO: _____mL 8hr In: __________ Out: __________ Balance: __________
1600
1800 24hr In: ___________ Out: ___________ Balance: __________ LOS Bal: _______
2000 LINES / TUBES / DRAINS / DEVICES
2200 PIV #1 Site: __________ Gauge: ___ Date: __________
HEMODYNAMICS PIV #2 Site: __________ Gauge: ___ Date: __________
Central Line / PICC Site: _______ Lumens: ___ Date: ___
Arterial Line: CVP: ___ MAP: ___ SVR: ___
Arterial Line Site: __________ Date: __________
CO/CI: ___/___ PA: S/D/M ___/___/___ PCWP: ___
PA Catheter Site: __________ Date: __________
ICP: ___ CPP: ___ EVD Lvl: ___cmH■O EVD Out: ___mL
Foley Catheter Fr: ___ Date: __________
SvO2: ___ ScvO2: ___ PICCO: ___ Thermodil CO: ___
NGT / OGT / Dobhoff Type: ______ Placement confirmed ■
CARDIAC RHYTHM / TELEMETRY
Chest Tube Site: _______ Suction: ___cmH■O Out: ___
Rhythm: NSR ■ Afib ■ Aflutter ■ VT ■ VF ■ PEA ■ Other: ___
EVD / ICP Monitor Level: ___ Zeroed ■ Date: _______
Pacer: None ■ Transcut ■ Transven ■ Rate: ___ Sense: ___ Other: _____________________________________________
12-Lead: Date: __________ Findings: _____________________
LVAD/IABP: Type: _______ Rate: ___ Ratio: ___ Mode: ______
VENTILATOR SETTINGS & RESPIRATORY MANAGEMENT
MODE TV (mL) RR Set FiO2 % PEEP Pres Sup I:E Ratio Flow Peak Pres Plateau Compliance
Spont RR: ___ Spont TV: ___ Min Vol: ___ ETT/Trach: ___ Size: ___ Cm @ lip: ___ Cuff: ___ ETCO2: ___
ABG / VBG RESULTS
TIME pH PaCO2 PaO2 HCO3 BE SpO2 FiO2 P/F Ratio Lactate Interpretation
DRIPS / VASOACTIVES / CONTINUOUS INFUSIONS
MEDICATION / DRIP CONC. RATE mL/hr DOSE TITRATION PARAMETERS LAST CHANGE GOAL / RESPONSE
Norepinephrine (Levophed)
Vasopressin
Epinephrine
Dopamine / Dobutamine
Phenylephrine
Milrinone / Nitroprusside
Propofol
Dexmedetomidine (Precedex)
Fentanyl / Dilaudid / Morphine
Other:
CRITICAL LABS & DIAGNOSTICS
BMP / CMP CBC COAG CRITICAL
Na+ WBC PT / INR Lactate
K+ Hgb aPTT Procalcitonin
Cl- Hct Anti-Xa CRP
CO2 Platelets D-Dimer Troponin
BUN Bands Fibrinogen BNP/proBNP
Creatinine Fibrinogen Thrombin Albumin
Glucose Lymphs TT Phos / Mg / Ca
Anion Gap Monos CK / CK-MB
Cultures / Imaging / Echo / EEG / Other Results:
ICU NURSING BRAIN SHEET | Confidential Patient Information | © 2025
★ INTENSIVE CARE UNIT PATIENT CARE TEMPLATE ★ PAGE 1 OF 2
Pg 1/2
SHIFT INFORMATION
DATE: SHIFT: ■ Days ■ Eves ■ Nights NURSE: UNIT / BED #:
PATIENT INFORMATION
ROOM / BED: PATIENT NAME: DOB / AGE: MRN: ATTENDING / FELLOW: CODE STATUS:
ALERTS & PRECAUTIONS
■ NKDA ALLERGIES: ■ FALL RISK ■ DNR/DNI ■ DNI ONLY ■ FULL CODE ■ CONTACT ■ DROPLET ■ AIRBORNE ■ MRSA ■ C-DIFF ■ VRE
DIAGNOSIS / REASON FOR ADMISSION / PMH / SURGICAL HX
VITALS (Each Assessment Time) INTAKE & OUTPUT (Hourly / Running Totals)
TIME HR BP / MAP RR SpO2 Temp Pain INTAKE OUTPUT
0000 SOURCE / TYPE AMT (mL) TIME SOURCE / TYPE AMT (mL) TIME
0200 PO / Oral Urine
0400 IV Fluids — Maint Foley / Drain
IV Fluids — Bolus Chest Tube
0600
Blood / FFP / Plts Emesis / NG
0800
TPN / Tube Feed Wound / Ostomy
1000
Medications (IV) Dialysis UF
1200
Other Other
1400
Hourly UO: _____mL 8hr In: __________ Out: __________ Balance: __________
1600
1800 24hr In: ___________ Out: ___________ Balance: __________ LOS Bal: _______
2000 LINES / TUBES / DRAINS / DEVICES
2200 PIV #1 Site: __________ Gauge: ___ Date: __________
HEMODYNAMICS PIV #2 Site: __________ Gauge: ___ Date: __________
Central Line / PICC Site: _______ Lumens: ___ Date: ___
Arterial Line: CVP: ___ MAP: ___ SVR: ___
Arterial Line Site: __________ Date: __________
CO/CI: ___/___ PA: S/D/M ___/___/___ PCWP: ___
PA Catheter Site: __________ Date: __________
ICP: ___ CPP: ___ EVD Lvl: ___cmH■O EVD Out: ___mL
Foley Catheter Fr: ___ Date: __________
SvO2: ___ ScvO2: ___ PICCO: ___ Thermodil CO: ___
NGT / OGT / Dobhoff Type: ______ Placement confirmed ■
CARDIAC RHYTHM / TELEMETRY
Chest Tube Site: _______ Suction: ___cmH■O Out: ___
Rhythm: NSR ■ Afib ■ Aflutter ■ VT ■ VF ■ PEA ■ Other: ___
EVD / ICP Monitor Level: ___ Zeroed ■ Date: _______
Pacer: None ■ Transcut ■ Transven ■ Rate: ___ Sense: ___ Other: _____________________________________________
12-Lead: Date: __________ Findings: _____________________
LVAD/IABP: Type: _______ Rate: ___ Ratio: ___ Mode: ______
VENTILATOR SETTINGS & RESPIRATORY MANAGEMENT
MODE TV (mL) RR Set FiO2 % PEEP Pres Sup I:E Ratio Flow Peak Pres Plateau Compliance
Spont RR: ___ Spont TV: ___ Min Vol: ___ ETT/Trach: ___ Size: ___ Cm @ lip: ___ Cuff: ___ ETCO2: ___
ABG / VBG RESULTS
TIME pH PaCO2 PaO2 HCO3 BE SpO2 FiO2 P/F Ratio Lactate Interpretation
DRIPS / VASOACTIVES / CONTINUOUS INFUSIONS
MEDICATION / DRIP CONC. RATE mL/hr DOSE TITRATION PARAMETERS LAST CHANGE GOAL / RESPONSE
Norepinephrine (Levophed)
Vasopressin
Epinephrine
Dopamine / Dobutamine
Phenylephrine
Milrinone / Nitroprusside
Propofol
Dexmedetomidine (Precedex)
Fentanyl / Dilaudid / Morphine
Other:
CRITICAL LABS & DIAGNOSTICS
BMP / CMP CBC COAG CRITICAL
Na+ WBC PT / INR Lactate
K+ Hgb aPTT Procalcitonin
Cl- Hct Anti-Xa CRP
CO2 Platelets D-Dimer Troponin
BUN Bands Fibrinogen BNP/proBNP
Creatinine Fibrinogen Thrombin Albumin
Glucose Lymphs TT Phos / Mg / Ca
Anion Gap Monos CK / CK-MB
Cultures / Imaging / Echo / EEG / Other Results:
ICU NURSING BRAIN SHEET | Confidential Patient Information | © 2025
