Note: NO identifiable resident information should be included Student: Savanna Chambers Date: March 13th, 2017

Nursing Diagnosis # Nursing Diagnosis #

*Supporting Data: *Supporting Data:

Diagnosis:

Medical History:

Allergies:
Code Status: DNR Level B

Nursing Diagnosis # Nursing Diagnosis #

*Supporting Data:
*Supporting Data:

*This should support the nursing diagnosis and may include assessment data such as: interview data, direct/indirect observation, physical assessment,
medical records review, and analysis and synthesis of available laboratory and other diagnostic studies (Gulanick & Myers, 2017, p 3)
 Note: NO identifiable resident information should be included Student: Savanna Chambers Date: March 13th, 2017

Nursing Diagnosis # Nursing Diagnosis #

Goal:
Goal:

Interventions:
Interventions:
1.
1.
2. 2.
3. 3.

Evaluation: Evaluation:

Nursing Diagnosis # Risk for falls Nursing Diagnosis # Readiness for enhanced coping

Goal: Goal:

Interventions:
Interventions:
1.
1.
2 2.
3. 3.

Evaluation: Evaluation:

Additional Care Info:

Note: NO identifiable resident information should be included Student: Savanna Chambers Date: March 13th, 2017

Notes: