KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬

Ministry of Higher Education ‫وزارة التعليم العالي‬

University of Ha’il ‫جامـعـة حـائل‬
College of Nursing ‫كلية التمريض‬

EVALUATION TOOL FOR CASE STUDY

Name of Student: ___________________________________ Date: ____________ Total Awarded Points: ______

Title of
the Case
Care of a Client with _________________________________________
Study

POINTS
Items Comments / Notes
Possible Awarded
A. Client’s Health Profile (Narrative)
a. Demographic Data: Date and Time of admission ;
Nursing Unit; Marital Status; Age; Nationality;
Education Level; Occupation (2.5 Marks)
b. Chief complaint(2.5 Marks)
CLO 1.1

c. History of Present Illness (2.5Marks) 10

d. Past Surgical and Medical Illness(Previous
hospitalization, previous surgeries, family history,
allergies(2.5 Marks)

B. Disease Process
a. Definition (1 Marks)
CLO 1.1

b. Anatomy (2 marks)
c. Pathophysiology (Diagram)(10 marks)
15
d. Clinical Manifestations (1 Marks)
e. Complications (1 Mark)

C. Physical Examination(Affected System)

a. Inspection (2.5 Marks)
b. Palpation (2.5 Marks)
CLO 2.1

c. Percussion (2.5 Marks)

10
d. Auscultation (2.5 Marks)
(include Vital signs)

D. Diagnostic Tests and Procedures (Tabulated)

a. Type of test/procedure and Purpose (3 Marks)
b. Results (1 Mark)
CLO 2.5

c. Reference Values (1 Mark)

10
d. Interpretation (5 Marks)

Evaluator’s Name & Signature: Student’s Signature:

_______________________________________________ ________________________________________________
 KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬
Ministry of Higher Education ‫وزارة التعليم العالي‬
University of Ha’il ‫جامـعـة حـائل‬
College of Nursing ‫كلية التمريض‬

EVALUATION TOOL FOR CASE STUDY

Name of Student: ___________________________________ Date: ____________ Total Awarded Points: ______

E. Drug Study (Tabulated)

a. Generic Names ( 1 Mark)
b. Trade Names (1 Mark)
c. Classifications (1Mark)
CLO 2.1

d. Indications (2 Mark) 10
e. Dose, Route, and Frequency (2 Mark)
f. Nursing Responsibilities (3 Marks)

F. Nursing Care Plan (Tabulated)

A.Assessment:
CLO2.1

 Subjective Data (1 Mark)

3
 Objective Data (2 Marks)

B.Nursing Diagnoses:
CLO 2.1

a. Derived from Assessment (1 Marks)

b. Formulate Nursing Diagnoses:
(Problem, Etiology, Defining Characteristics) (3 Marks) 10
c. Actual Nursing Diagnosis ( 3 marks )
d. Potential Nursing Diagnosis ( 3 Marks)

C.Planning:
CLO 2.1

Specific Objective(SMART)
2

D.Interventions:
CLO 2.1

a. Independent (2.5Marks)
b. Dependent (2.5Mark)
c. Collaborative (1 Mark) 10
d. Rationale (4 Marks)

Evaluator’s Name & Signature: Student’s Signature:

_______________________________________________ ________________________________________________
 KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬
Ministry of Higher Education ‫وزارة التعليم العالي‬
University of Ha’il ‫جامـعـة حـائل‬
College of Nursing ‫كلية التمريض‬

EVALUATION TOOL FOR CASE STUDY

Name of Student: ___________________________________ Date: ____________ Total Awarded Points: ______

e. Evaluation of Care:
CLO 2.1

Actual Outcome (2 Marks)

G. Individual Presentation:
CLO Mastery of the topic
3
1.1
CLO Communication skills
3
2.4
CLO Able to answer the questions correctly.
3
1.1
CLO Promoting group interaction
3
2.5
CLO Visual Aids
3
2.6
CLO References:
3
2.6 Books or website:
TOTAL Score ____X 15% =
100

Evaluator’s Name & Signature: Student’s Signature:

_______________________________________________ ________________________________________________