CNU-CN FORM 002

Cebu Normal University

College of Nursing Cebu City Mission-Vision: Care Using Knowledge and Compassion
NCP Scoring System Nursing Dx 10 pts 2 pts Defining Characteristics Outcome 3 pts 1 pt Intervention Bibliography 3 pts 1 pt (at least 5 references)

Clients Name: Age: Sex:

Civil Status:

Religion:

Patient Care Classification: (Please check) Wholly Compensatory: Pts. therapeutic self-care is accomplished
by nurse

Allergies: Food: Drug: Diet: Date of Admission: Diagnosis:

Partially Compensatory: Pt. performs some self-care measures Supportive Educative: Pt. accomplishes self-care measures Clinical Division and Bed No. Name of Physician: Name of Student:

EXPECTED OUTCOME CRITERIA

INTERVENTION AND RATIONALE

BEHAVIORAL OUTCOME

DEFINING CHARACTERISTICS

DEFINING CHARACTERISTICS

EXPECTED OUTCOME CRITERIA

INTERVENTION AND RATIONALE

BEHAVIORAL OUTCOME