Medication Dose Class/Action = 1st diagnosis Expected

= vital signs, diagnostic tests, nrsg. Assessment Subjective

Expected Data
= intervention
= nurse outcome Subjective
= nursing diagnosis Data

=Continued Evaluation

Expected Expected Labs

Vital Signs
Expected Physical
Assessment

Collaborative Nursing
Intervention #1 Intervention #1 Diagnostic Diagnostic
Test Test
Nursing Priority #1

Collaborative Nursing Intervention Collaborative

Intervention #2 #2 Disease/Disorder Intervention #1 Nursing Priority
#3

SMART
Outcome #1
“Pt will…” Collaborative
Nursing Intervention #2
Intervention #3 SMART
Collaborative Outcome #3
Evaluation #1 “Pt will…”
Intervention #3
Nursing Priority #2 Collaborative
Outcome met? Intervention #3
Nursing
Collaborative Nursing Intervention #1
Intervention #1 Intervention #1

SMART Nursing
Nursing Intervention #2
Risks/Predisposing Factors Outcome #2 Intervention #2
Collaborative “Pt will…”
 Intervention #2

Evaluation #2 Evaluation #3
Collaborative Nursing
Intervention #3 Outcome met? Intervention #3 Outcome met?