NURSING CARE PLAN

Patient’s Name: Hospital No. :

Age: Room No. :
Impression/Diagnosis: Physician:
Nurse’s Name & Signature:

CLINICAL PORTRAIT PERTINENT DATA

 NURSING
RATIONALE OF
NURSING SCIENTIFIC GOAL & OUTCOME ACTIONS &
CUES NURSING EVALUATION
DIAGNOSIS BASIS CRITERIA NURSING
ORDERS
ORDERS
 UNIVERSITY OF CEBU-BANILAD
COLLEGE OF NURSING

DRUG STUDY
Patient’s Name: Age: Hospital No.: Room No.:
Impression/Diagnosis: Attending Physician:
Allergy to:

Generic & Dose, Strength Indication/Mechanisms of Adverse/Side Effects Nursing Client

Rationale
Brand Name & Formulation Drug Action Drug Interaction Responsibilities Teaching

Generic: Ordered: Indications:

Timing:

Brand: Duration:
Mechanism of Action:
Other forms:
 UNIVERSITY OF CEBU-BANILAD
College of Nursing
Cebu City

MEDICATION FLOWSHEET
Student’s Name: Date of Submission:
Area: Clinical Instructor:
Shift: