NURSING CARE PLAN

Hospital: Ward: Hospital No:

Name of the Patient: Age: Sex:
Address: Date of Admission: Physician/(s):
Chief complaint/(s): Diagnosis:

CUES/ NEEDS DIAGNOSIS SCIENTIFIC BASIS OBJECTIVES NURSING RATIONALE EVALUATION

INTERVENTIONS
 HEALTH TEACHING PLAN
Hospital: Ward: Hospital No:
Name of the Patient: Age: Sex:
Address: Date of Admission: Physician/(s):
Chief complaint/(s): Diagnosis:

HEALTH PROBLEM LEARNING LEARNING CONTENTS SCIENTIFIC INDEPENTDENT METHOD OF EVALUATION

OBJECTIVES NURSING INTERVENTIONS TEACHING
 DRUG THERAPEUTIC RECORD

BRAND NAME DRUG CLASSIFICATION INDICATIONS ADVERSE EFFECTS NURSING RESPONSIBILITIES

GENERIC NAME PREGNANCY CATEGORY

/PREGANANCY / LACTATION

ROUTE OF
ADMINISTRATION
AND DOSE

CONTRAINDICATION /
MECHANISM OF ACTION PRECAUTION / INTERACTIONS SIDE EFFECTS
 DIAGNOSTIC RESULTS
Hospital: Ward: Hospital No:
Name of the Patient: Age: Sex:
Address: Date of Admission: Physician/(s):
Chief complaint/(s): Diagnosis:

DATE DIAGNOSTIC TEST NORMAL VALUES PATIENT’S RESULT SIGNIFCANCE SOURCE

Color
Consistency
 FOCUS CHARTING

Hospital: ____________________________________________ Ward: Hospital No: _______________________________

Name of Patient: _____________________________________ Age: Sex: ______________________________________
Address: ____________________________________________ Date of Admission: Physician/(s): ______________________________
Chief Complaint/(s): ___________________________________ Diagnosis:

FOCUS DATA- ACTION- RESPONSE

 PLAY THERAPY

Hospital: ____________________________________________ Ward: Hospital No: _______________________________

Name of Patient: _____________________________________ Age: Sex: ______________________________________
Address: ____________________________________________ Date of Admission: Physician/(s): ______________________________
Chief Complaint/(s): ___________________________________ Diagnosis:

Objectives Type of Play and Description Significance Evaluation

 DISCHARGE PLAN
Hospital: Ward: Hospital No:
Name of Patient: Age: Sex:
Address: Date of Admission: Physician/(s):
Chief Complaint/(s): Diagnosis:

NAME OF DRUGS DOSAGE FREQUENCY ROUTE SIDEEFFECETS CURATIVE EFFECTS

EXERCISE\ACTIVITY: OBSERVED SIGNS AND SYMPTOMS THAT NEED REPORTING:

TREATMENT: SPIRITUAL AND PSYCHOLOGICAL NEEDS:

HEALTH TEACHING: DISCHARGE DETAILS:

A. Date& Time of Discharge:

B. Accompanied by:
C. Mode of Transport:
D. General Condition Upon Discharge:

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Patient\Relative Student Nurse Clinical Instructor

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