NURSING CARE PLAN

Name of Patient:____________________________________________________________________________Age:_____________Civil Status:____________________Religion:_____________________________________________________________

Address:______________________________________________________________________________________Informant:_________________________________Relationship:______________________________________________________________
Chief Complaint:____________________________________________________________________________Medical Diagnosis:______________________________________________________________________________________________________

IMPLEMENTATION

ASSESSMENT Rationale/Justifications
PLANNING
PROBLEM LIST (cues & evidences/ (Nursing Theories of Care,
DATE NURSING DIAGNOSIS (objectives-long term EVALUATION
(according to priority) objective &
& short term) Developmental stage,
subjective) Nursing Interventions References
tasks, Principles, EBP,
Standards of Nursing
Practice)

Name of Student Nurse and Signature:_____________________________________________________________Year and Section:______________________Date/Duration of Patient Care:__________________________________

Name of Clinical Instructor:_________________________________________________________________________________________Rating:________________________Remarks:________________________________________________________