TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines

Name: Section:

JOURNAL READING REFLECTION

 TARLAC STATE UNIVERSITY
COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines

Name Area
Inclusive dates of
Year Level RLE Group
Rotation
Name of
Age Gender
Patient
Date
Diagnosis
Admitted

SOPIE/CHARTING
 TARLAC STATE UNIVERSITY
COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Phase I Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines

Name Area
Year Level RLE Group Inclusive dates of Rotation
Name of Patient Age Gender
Date Admitted Diagnosis

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

 TARLAC STATE UNIVERSITY
COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Phase I Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines

Name Area
Year Level RLE Group Inclusive dates of Rotation
Name of Patient Age Gender
Date Admitted Diagnosis

DRUG STUDY

DRUG NAME DOSAGE AND MECHANISM OF INDICATION CONTRAINDICATION SIDE EFFECTS NURSING
ROUTE ACTION INTERVENTION
 TARLAC STATE UNIVERSITY
COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines

CLINICAL CASE ANALYSIS

Name of Patient Age: Gender:

Address Date Admitted:
Diagnosis

NURSING HISTORY:

PATHOPHYSIOLOGY:

DIAGNOSTIC PROCEDURES:

MEDICAL MANAGEMENT:

Name of Student:
Date Submitted: C.I.’s Signature

Form No.: TSU-COS-SF-04 Revision No.: 00 Effectivity Date: June 22, 2016 Page 1 of 1
 TARLAC STATE UNIVERSITY
COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines

PATIENT EDUCATION FORM

Name Area
Inclusive
Year Level RLE Group dates of
Rotation
Name of
Age Gender
Patient
Date
Diagnosis
Admitted

MAIN CONCEPT / TOPIC:

Details of Patient Education Content:

Patient’s Signature / Significant Other’s Signature

Date Signed
Date Submitted