RLE FORM 002

Cebu Normal University College of Nursing Cebu City Mission-Vision: Care Using Knowledge and Compassion

NURSING CARE PLAN NCP Scoring System pts Nursing Dx least 5 references) 10 pts 2 pts Defining Characteristics Outcome 3 pts 1 pt Intervention Bibliography 3 1 pt (at

Clients Name: ________S.C_________________________ Patient Care Classification: (Please Check) Age: _54__ Civil Status: __Married_ Religion: _Roman Catholic__ _/__ Wholly Compensatory: Pts. therapeutic self-care is accomplished by nurse Allergies: Food: _______none known____________________ ___ ____ Partially Compensatory: Pts. performs some self-care measures Drug: ____none known__________________________ ___ ____ Supportive Educative: Pts accomplishes self-care measures Diet: _blenderized feeding _______________________ Date of Admission: ___6/17/2011__________________________ Clinical Division and Bed No: ____X-22_______________________ Diagnosis _PTB with Pneumoinia, R/I Tabes Mesenterica, Anemia Name of Physician: _Dr. Ababon_____________________ ________of_Chronic Illness, R/O UGIB 2 to BPUD ____________ Name of Student: __Fat, Demilyn O.___________________

DEFINING CHARACTERISTICS

EXPECTED OUTCOME CRITERIA (Ideal)

INTERVENTION AND RATIONALE

BEHAVIORAL OUTCOME (ACTUAL)

Nursing Diagnosis:

Short term Goal: Within

Independent:

8hrs of nursing I>

interventions, the patient

S:

and his SO will

Long term Goal:

Within 2-3days of nursing interventions, the patient will

Laboratory:

Theoretical Basis:
Independent cont. interventions

I> )
DEFINING CHARACTERISTICS EXPECTED OUTCOME CRITERIA (Ideal) BEHAVIORAL OUTCOME (ACTUAL)

INTERVENTION AND RATIONALE

Dependent/Collaborative:

I>

Bibliography: