Nursing 201/202 Care Plan

Student Name: PT Initials: Age: M F RM#: Diagnosis and Definition: Clinical Dates: Med/Surg History: Thurs: Wgt: T P T P Friday: Wgt: T P T P Problems Related to Surgical Procedure and Significant Medical History VITAL SIGNS Scale: R BP R BP Scale: R BP R BP Nursing Diagnosis

Activity Level: Diet: Allergies: Description of Surgical Procedure:

Lab Abnormalities: Expected: Treatments: Actual: Interventions for Each Problem/Diagnosis Evaluation Criteria

Revised 8/08 MAT

Nursing 201/202 Care Plan
Patient Teaching Implemented:

Discharge Planning: Consider: Long term goals, ADL assistance, Meals, Support person(s), Agency referral (s), Equipment

Documentation: Day 1:

Day 2:

Revised 8/08 MAT

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