NURSING CARE PLAN

Demographic data:-

Name:-

Age:-

Gender:-

I.P. D No.:-

Ward:-

Address:-

Education:-

Occupation:-

Marital status :-

Religion:-

Date of admission:-

Name of the surgery:-

Type of anesthesia:-

Allergic to:-

Date of discharge:-

Socio economic status:-

Personal history:-

Family history :-

Past medical history and surgical history:-

Present medical history:-

Present surgical history:-

Investigation:-

S.No. Date Name of investigation Patient’s value Normal value Remarks

 Medication:-

S.No. Name Dose/frequency/route Action Nurse’s

responsibility

Nursing care plan :-

Assessment Nursing Goal Planning Rationale Implementation Evaluation

diagnosis
Subjective data

Objective data

Health education:-

S.No. Date Topic

Nurse’s record :-

Date Recording Signature