Name of Student: ______________________________________ Year / Section: ____________ Date: ______________

Patient’s initial: ________ Doctor: (Initial only) _______

Age:______ Chief Complain: ________________________
Sex: ______ Diagnosis : ____________________________
OB SCORING: GTPAL OPERATION:

NURSING CARE PLAN

GENERAL OBJECTIVE:

ASSESSMENT NURSING PATHOPHYSIOLOGY EXPECTED SPECIFIC OBJECTIVES INTERVENTIONS/ RATIONALE EVALUATION

DIAGNOSIS (with Reference/s) OUTCOME Nursing Action:
Subjectives: Independent:
“ga sakit akon
tiyan”, as
verbalized by
the patient.

Dependent:

Objectives:
Pain scale:
8/10 (0-10)

Laboratory/
Diagnostic
Tests:

S/E or
fecalysis:
Urine analysis
or U/A Collaborative
CBC 15,000
mg/dL (5-10)