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Fluid Restriction Worksheet
FluidR
FrDietary
BrkFast
Lunch
Supper
FrNursing
Day Shift
Eve Shift
Ngt Shift
1000 cc
720 cc
240
240
240
280 cc
100
100
80
1100 cc
840 cc
360
240
240
260 cc
100
80
80
1200 cc
840 cc
360
240
240
360 cc
140
140
80
1300 cc
840 cc
360
240
240
460 cc
190
190
80
1400 cc
840 cc
360
240
240
560 cc
240
240
80
1500 cc
840 cc
360
240
240
660 cc
240
240
180
1600 cc
960 cc
360
240
360
640 cc
240
240
160
1700 cc
960 cc
360
240
360
740 cc
300
300
140
1800 cc
1080 cc
360
360
360
720 cc
300
300
120
1900 cc
1080 cc
360
360
360
820 cc
320
320
180
2000 cc
1080 cc
360
360
360
920 cc
360
360
200
2100 cc
1080 cc
360
360
360
1020 cc
410
410
200
2200 cc
1080 cc
360
360
360
1120 cc
460
460
200
  
  Diet
Total Dietary      Brk:    Lch:    Sup:
Total Nursing      Day:    Eve:    Night: