NURSING CARE PLAN

Assessment 3 points Goals 2 points Interventions 4 points Bibliography 1 point

Diagnosis 2 points Theoretical Basis 2 points Evaluation 1 point

Name of Student: Stressor Classification: (Please Check)

Client`s Initials: Physiological (body structure and functions)
Age: Gender: Civil Status: Religion: Psychological (mental process and emotion)
Allergies: Socio-cultural (relationships, social expectations)
Diet: Spiritual (influence of spiritual beliefs)
Date of Admission: Developmental (developmental processes over the lifespan
Diagnosis/Impression:

NURSING DIAGNOSIS NURSING GOALS NURSING OUTCOME

Assessment Diagnosis Mutual Planning Interventions Actual Evaluation
(Goal attainable w/in the shift) (with rationale and source)

PRIMARY INTERVETIONS
Subjective: Promotive:

Preventive:

Objective:

SECONDARY INTERVENTIONS
Theoretical Basis: Curative:

TERTIARY INTERVENTIONS
Rehabilitative:

Bibliography: