COLEGIO DE SAN LORENZO RUIZ DE MANILA
of Northern Samar
J.P. Rizal Street, Brgy. Calachuchi, Catarman Northern Samar
NURSING CARE PLAN
Name of Patient: ________________________ Date Admitted: _______________ Diagnosis: _________________
Age: _____ Gender: _________ Civil status: _______ Institution: ________________ Ward: ________________
ASSESMENT NURSING
DIAGNOSIS
OBJECTIVES/
PLANNING
NURSING
INTERVENTIONS
RATIONALE EVALUATION
Subjective data:Nursing
diagnosis:
Rationale:
Short term
objectives:
Independent:
Dependent:
Independent:
Dependent:
Short term:
Objective Data:
References:
Long term
objectives:
Collaborative: Collaborative:
Long term;
*Accomplish a separate sheet if necessary
STUDENT NURSE: Rizaldo F. Cisneros CLINICAL INSTRUCTOR: Ms. Shannen Figueroa, RN
COLEGIO DE SAN LORENZO RUIZ DE MANILA
of Northern Samar
J.P. Rizal Street, Brgy. Calachuchi, Catarman Northern Samar
NURSING CARE PLAN
Name of Patient: ________________________ Date Admitted: _______________ Diagnosis: _________________
Age: _____ Gender: _________ Civil status: _______ Institution: ________________ Ward: ________________
ASSESMENT NURSING OBJECTIVES/ NURSING RATIONALE EVALUATION
DIAGNOSIS PLANNING INTERVENTIONS
Subjective data:
Objective Data:
Nursing
diagnosis:
Rationale:
References:
Short term
objectives:
Long term
objectives:
Independent:
Dependent:
Collaborative:
Independent:
Dependent:
Collaborative:
Short term:
Long term;
*Accomplish a separate sheet if necessary
STUDENT NURSE: Jefferson Tenedero CLINICAL INSTRUCTOR: Ms. Shannen Figueroa, RN