Name of Patient: Age/Sex: 43/Male Rm.

/Bed #: ___
Chief Complaint: Physician: _______________________________
Diagnosis: ___________________________________________________________________________________________________

DATE/TIME CUES NEED NURSING GOAL OF CARE NURSING IMPLEME EVALUATION

DIAGNOSIS INTERVENTIONS NTATION
S
Subjective: Imbalance nutrition:
Less than body
“wala nako mahurot requirement related
akong pagkaon kay to liver impairment
wala koy gana” as as evidenced by
verbalized by the loss of weight
patient.

Objective:

Losing weight
Loss of appetite
Unfinished meals

BMI – 17.8 =
underweight
Weight – 48.5
Height – 5’5