Please complete the outpatient journal on your child. The information is very
useful to us to follow your child's progress. The journal aids us in identifying
areas of concern. Upon returning home, please continue to complete the journal.
These can be useful to your local doctor as well.
Temperature: Take and record your child' temperature each day and additionally
if your child feels warm. Call if temp is > 38°C.
Central line site: Note any drainage, redness, swelling or tenderness
at exit site or along the tract. Call if your child experiences chills or fever
after flushing the central line.
Sleep: Record how well your child slept (fair, poor, okay, great or
number of hours, times awake).
Appetite/nausea/vomiting/diarrhea: Note any changes in appetite, any
nausea, vomiting or diarrhea.
Oral care: Note any changes in the oral mucosa such as bleeding, white
patches, dryness, etc.
Skin: Record any changes in skin especially rashes, bruising and location
(face, chest).
Urine: Note any blood in urine, pain or discomfort with urination, decrease
in urine output.
Cough/shortness of breath/tolerance: Note any changes such as a cough,
increased respiratory rate, decrease in tolerance to activities (i.e., walking
up stairs).
Activity: Record duration and type of exercise.
Spirometer: Record the height the child is able to obtain using the
spirometer.
Additionally, please note any medication changes, significant lab values (i.e.,
potassium level) or additional information you feel is important.
Please return the form to us weekly by mail, fax or your next visit. FAX: (319)
356-3434.
Report any changes in your child's condition or any concerns to your physician.
If any of the following occurs, please contact your physician promptly:
- Fever - temperature greater than 38°C (100.4°F)
- Any drainage at central line exit site.
- Persistent nausea/vomiting/diarrhea.
- Any shortness or breath, increased respiratory rate at rest, cough or decreased
tolerance of activities.
- Any blood in urine.
Title
Page
|
