CSU, STANISLAUS MENTAL HEALTH NURSING PLAN OF CARE

Student name___________________________________________________________________Date of care__________________Room number___________

Patient Data
Admitting Diagnosis(es):____________________________________________________________________________________________________________
Patients Initials_____ Gender________ Age________ Educational Level____________________ Primary Language____________________
Precautions: Suicide_____Homicide_____Admitting Date__________Vital Signs: T________R________P________B/P_________________
DSM IV AXIS: I____________________II___________________III__________________IV__________________V: current GAF_____ Highest GAF______
Past Psychiatric Hospitalizations________________________________________________________________________________________
Use of Alcohol/Drugs (type, frequency, duration)___________________________________________________________________________
Family History (mental health, alcohol/drug abuse, abuse/neglect):_____________________________________________________________
Spiritual Assessment______________________________________________________________________________________________________________
Cultural Assessment______________________________________________________________________________________________________________
Pain Assessment scale 0-10__________Location of pain__________________________Rx or other for pain_______________________________________
Psych Testing Date_________________Results:_______________________________________________________________________________________
Date

Lab Test

Patient Value

Normal Value

Nursing Implications

ALLERGIES_____________________________________________________________________________________________
Medication
Name

Route/Time

Effects of Rx on Symptoms

Side Effects

Nursing Implications