Daily Organizational Plan

Student Name: _____________________________________ Date: _____________________

Clients Initials: _______ Room: _______ Age: _______ Staff Nurse: _____________________

Primary Diagnosis: ______________________________________________________________

Co-existing Conditions: __________________________________________________________

Hygiene: __________________ Activity: __________________ Diet: __________________

Dressings: _________________ Tubes: ___________________ O2: _______________

Elimination: ______________ Mobility: _________________ DNR: ________________

Vital Signs:____________________________________________________________________

Tests: ______________________________ Prep Required: __________________________

MEDICAL DIAGNOSIS: Define & clinical manifestations of diagnosis and co-existing Conditions

PRIORITY ASSESSMENTS: Related to all diagnoses & conditions

PERTINENT LAB DATA DIAGNOSTIC TESTS (Pre/Post Care)

Medication1 ________________ Alter name _______________ Dosage_______________

Classification __________________________ Route _____________ Time ____________
Indication ____________________________ Side Effect ____________________________
Intervention _________________________________________________________________
Education ___________________________________________________________________
Medication2 ________________ Alter name ________________ Dosage ______________
Classification __________________________ Route _____________ Time ____________
Indication ____________________________ Side Effect ____________________________
Intervention _________________________________________________________________
Education ___________________________________________________________________
 TENTATIVE ORGANIZATIONAL PLAN

Patient Name:
Meds Time Original Revised Meds Time Original Revised
0700 1300

0730 1330

0800 1400

0830 1430

0900 1500

0930 1530

1000 1600

1030 1630

1100 1700

1130 1730

1200 1800

1230 1830

Client
Problems

Medication ________________ Alter name ________________ Dosage_______________

Classification __________________________ Route _____________ Time ____________
Indication ____________________________ Side Effect ____________________________
Intervention _________________________________________________________________
Education ___________________________________________________________________

Medication ________________ Alter name ________________ Dosage_______________

Classification __________________________ Route _____________ Time ____________
Indication ____________________________ Side Effect ____________________________
Intervention _________________________________________________________________
Education ___________________________________________________________________

REPORT
Priority Checks AM PM