Pamantasan ng Cabuyao

(University of Cabuyao)
COLLEGE OF HEALTH AND ALLIED SCIENCES
Katapatan Mutual Homes, Brgy. Banay-banay, Cabuyao City, Laguna 4025

BACHELOR OF SCIENCE IN NURSING

NURSING CARE PLAN FORMAT /50

Patient Initial: ___________________ Age: _____________________ Date: _____________________ Student Name: ____________________ Score:
Admitting Diagnosis/Current/Medical Diagnosis: ______________________________________________________________________________________________
Definition(2pts): _______________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

● Include only the supporting data cluster ● Include functional health patterns ● Outcomes & evaluative ● Prescribed interventions, & rationales. ● Evaluate outcomes& evaluative criteria
related to each diagnosis (6 pts.) criteria: (4 pts.)
● Nurse will:
(6 pts.) ● Patient will: (20 pts)
(10 pts.)

1. 1.
 Pamantasan ng Cabuyao
(University of Cabuyao)
COLLEGE OF HEALTH AND ALLIED SCIENCES
Katapatan Mutual Homes, Brgy. Banay-banay, Cabuyao City, Laguna 4025

BACHELOR OF SCIENCE IN NURSING

Citation in APA Format (2 pts):

Submitted by: Checked/Evaluated by:

__________________________________ _________________________________
Student’s Name and signature Clinical Instructor Name and signature