Name of Student: ___________________________________ Date of Assignment: __________________________

Name of Patient: ____________________________________ Civil Status: __________ Ward: ________________

Diagnosis or Clinical Impression: ______________________ Age: _________________ Sex: _________________
Bed No.______________
CUES NURSING DIAGNOSIS BACKGROUND KNOWLEDGE GOALS AND OBJECTIVES
(Defining Characteristics of
Nursing Diagnosis)
(Problem and Etiology
(Pathophysiologic/Physiological
explanation of consequences of the
nursing Diagnosis)
(Includes Long and Short term
Objectives)
NURSING INTERVENTIONS RATIONALE
Bulacan State University
COLLEGE OF NURSING
City of Malolos, Bulcan
NURSING CARE PLAN
EVALUATION
Bulacan State University
COLLEGE OF NURSING
City of Malolos, Bulcan
NURSING CARE PLAN