Aklan Catholic College

Archbishop Gabriel M. Reyes St.

5600 Kalibo, Aklan, Philippines
Tel. Nos.: (036)268-4152; 268-9171
Fax No.: (036)268-4010
Website: http://www.acc.edu.ph
RATING: ____________
E-mail Add: aklancollege@yahoo.com
Ci’s Initials: __________
NURSING DEPARTMENT

NURSING CARE PLAN

Name of Patient: __________________________________________ Age/Sex: _____________ Ward/Bed Number: __________________ Date Accomplished: ________________
Impression/Diagnosis: __________________________________________________________________ Attending Physician:
__________________________________________________________
Clustered Cues Nursing Diagnosis Objectives of Care/
Rationale Nursing Interventions Rationale Evaluation
(Objective & Subjective s/sx) Outcome Criteria

(Reference: include year of

publication & page number)
Student’s Name: _____________________________________________________________________ Clinical Instructor: ________________________________________________________________
Aklan Catholic College
Archbishop Gabriel M. Reyes St.
5600 Kalibo, Aklan, Philippines
Tel. Nos.: (036)268-4152; 268-9171
Fax No.: (036)268-4010
Website: http://www.acc.edu.ph
RATING: ____________
E-mail Add: aklancollege@yahoo.com
CI’s Initials: __________
NURSING DEPARTMENT

DRUG STUDY
Name of Patient: __________________________________________ Age/Sex: _____________ Ward/Bed Number: __________________ Date Accomplished: ________________
Impression/Diagnosis: __________________________________________________________________ Attending Physician:
__________________________________________________________
Dosage, Route,
Name of Drug Mechanism of Action Indication Adverse Reactions Special Precautions Nursing Responsibilities
Frequency, Timing

Generic: Dosage:

Brand: Route:

Classification Contraindication Side Effects

Frequency:

Functional:

Timing:
 (Reference: include year of
publication & page number)

Student’s Name: _____________________________________________________________________ Clinical Instructor: ________________________________________________________________