FM-CON-1023

Revision No. 00
VIRGEN MILAGROSA COLLEGE OF Effectivity Date: Nov.5, 2018
UNIVERSITY FOUNDATION NURSING

CASE STUDY

Name of student: ____________________________________________

Year: ______________

GENERAL INFORMATION:

Name:

Admission Date:

Admission Time:

Admitting Physician:

Chief complaint:

Admitting Diagnosis:

Pathophysiology

II. DEVELOPMENTAL DATA

 FM-CON-1023
Revision No. 00
VIRGEN MILAGROSA COLLEGE OF Effectivity Date: Nov.5, 2018
UNIVERSITY FOUNDATION NURSING

III. HEALTH HISTORY

A. FAMILY HISTORY

B. PAST MEDICAL HISTORY:

C. PRESENT ILLNESS:

Physical Exam:

Skin:

Head:

Eyes:

Nose:

Neck:

Chest:

Heart:

Lungs:

Abdomen:

Genito-Urinary System:

Nervous system:
 FM-CON-1023
Revision No. 00
VIRGEN MILAGROSA COLLEGE OF Effectivity Date: Nov.5, 2018
UNIVERSITY FOUNDATION NURSING

IV. MEDICAL TREATMENT AND MANAGEMENT INCLUDING DIAGNOSTIC

PROCEDURES AND ITS INTERPRETATION TO NURSING.
 FM-CON-1023
Revision No. 00
VIRGEN MILAGROSA COLLEGE OF Effectivity Date: Nov.5, 2018
UNIVERSITY FOUNDATION NURSING

V: DRUG STUDY (INCLUDE GENERIC NAME, ACTIONS, SE, AND

CONTRAINDICATION (Use separate sheet/s if not enough)

Generic Name Indications Actions Side Effects/ Nursing

(Brand Name) if Contraindications Responsibilities
any
 FM-CON-1023
Revision No. 00
VIRGEN MILAGROSA COLLEGE OF Effectivity Date: Nov.5, 2018
UNIVERSITY FOUNDATION NURSING

VI: NURSING INTERVENTIONS AND RATIONALE (Use separate sheet/s if not enough)

Assessment Nursing Planning Intervention Rationale Evaluation

Diagnosis
 FM-CON-1023
Revision No. 00
VIRGEN MILAGROSA COLLEGE OF Effectivity Date: Nov.5, 2018
UNIVERSITY FOUNDATION NURSING

VII: NURSING IMPLICATIONS

A. NURSING PRACTICE

B. NURSING EDUCATION

C. NURSING RESEARCH

VIII: REFERRAL AND FOLLOW UP (IF ANY):

Submitted by:

_______________________________

Signature over printed name of student

Discussed with student by:

______________________________

Clinical Instructor

Certified by:

Ma. Theresa R. Aguilan RN MAN

Dean College of Nursing
 FM-CON-1023
Revision No. 00
VIRGEN MILAGROSA COLLEGE OF Effectivity Date: Nov.5, 2018
UNIVERSITY FOUNDATION NURSING