Name of patient: Date of admission: Room:

Age: Sex: Civil Status:

Chief of complaint: Religion: AP:

Problem Scientific Basis Goal & Objectives Interventions Rationale Evaluation

Date: Dx: After 8 hours

span of nursing
Subjective Cues: care, the patient
will be able to “Goal Not Met”
Rationale / show After 8 hours span
Scientific Basis: improvement as of nursing
evidenced by: intervention, the
patient:

Objective Cues:

Reference:
F.A. Davis. (2022)
Nurse’s Pocket
Guide (Sixteenth
Edition). C&E
Publishing, Inc