Record the date and time of administration. Note the Lasix dose administered in milligrams (mg). Specify the route of administration as intravenous (IV).
Document the patient’s weight in kilograms (kg) before administration. This is critical for dose calculation verification. Include the patient’s identification information, ensuring accuracy to prevent medication errors.
Describe the infusion rate in milliliters per hour (ml/hr) or the total infusion time. Detail the IV site used, noting any complications such as infiltration or phlebitis.
Record the patient’s vital signs immediately before, during (if applicable), and after Lasix administration. This includes blood pressure, heart rate, respiratory rate, and oxygen saturation.
Note any pre-existing conditions relevant to Lasix administration (e. g., hypokalemia). Document any observed adverse effects such as dizziness, hypotension, or hypokalemia. After administration, document the patient’s fluid balance.
Sign and date the entry, including your professional credentials. A legible and clear record reduces ambiguity and potential legal issues.
Remember: Accurate and thorough documentation is paramount. Any deviation from standard protocol should be explicitly noted.
