Endoscopy Nurse Brain Sheet | GI Lab Procedure Report Sheet (Print + Fillable PDF)

Made by a nurse with 10 years in ICU, trauma, surgery, and the ER. One page per patient that follows an endoscopy or GI lab case from the pre-procedure checklist through sedation, findings, recovery and discharge.

WHAT'S INCLUDED

• Patient info, allergies, code status, indication, endoscopist and room, NPO time, escort or ride home
• Pre-procedure checklist: consent, H&P, NPO, prep done, IV access, allergies checked, anticoagulant and diabetic meds held, escort present, pregnancy test
• History: HTN, DM, CAD or CHF, COPD or OSA, CKD, cirrhosis, GERD, IBD, prior GI bleed, difficult airway
• Anticoagulant and antiplatelet box with last doses and INR, plus home meds held or given
• Procedure type: EGD, colonoscopy, flex sig, ERCP, EUS, bronchoscopy, PEG placement, banding or bleed control
• Prep and airway: prep type and quality, last BM, Mallampati, O2 and capnography, position, time in and out
• Sedation record: drugs, total dose and times, reversal, Aldrete at end, plus a vitals table for BP, HR, SpO2 and EtCO2
• Findings, plus specimens and interventions: biopsy, polypectomy, banding, clips, dilation, stent, cautery
• Recovery checks table: BP, HR, SpO2, pain and bloating, abdomen, nausea and bleeding, initials
• Discharge criteria and orders, plus a handoff and to-do list

FORMATS: Moon theme / US Letter and A4 / Print version plus a fillable version for tablet or computer. 4 PDFs in the download.

Instant digital download. Nothing will be shipped.

For personal use. This is not a medical record or a substitute for your facility's charting, so always follow your unit's protocol. Follow your facility's privacy policy and shred after shift.

AI DISCLOSURE: Some design elements and mockup images were created with the help of AI tools. The layout and clinical content were designed by a registered nurse.