Nursing care plan

AL-Balqa Applied University

Clinical instructor: ------------------------------

Student name: ------------------------------------- date: ------------------------

Demographic data:

Child name: --------------------------------------

Age: ------------------------------- sex: ------------------------ admission date:

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Childhood stage: --------------------------------

Medical diagnosis: -------------------------------------

Allergies: ----------------------------------------------

Current body measurement:

Height in cm:

Weight in kg:

Head circumference in cm:

Chest circumference in cm:

Body mass index:

Body measurement interpretation:

Chief complains:

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History of present illness:

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Past history and Hospitalization:

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Immunization:

Dose child received his vaccines (yes/no)

HABITS:

Eating:

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Elimination:
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Sleeping:

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Behaviors (Temperament):

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Activity:

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Family history:

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General appearance:

1- Does child appear well or ill overall?

2- Does child appear well nourished?
3- What is the child color?
4- Is child posture normal?
5- What is the child hygiene level?
6- Does child appear relaxed or distressed, lethargic?
7- Is there any significant odor?
physical examination (system related to case)

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Base line data:

V/S Pulse Temperature Respiratory rate

Admission:

By student:

Current medication and I.V.F

Drug name Dose Classification Side effect Nursing action

frequency action
 Intake and output balance:

Fluid intake Fluid output

Laboratory investigation

Date Test Result Normal Nursing action

Range

Other procedure (according to the case) :

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Subjective data:

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Objective data:

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Nursing diagnosis (at least one nursing diagnosis)

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Planning:

Goal:
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Objective: -----------------------------------------
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Interventions:

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Evaluation:

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