Wesleyan University – Philippines

College of Nursing and Allied Medical Sciences

NURSING CARE PLAN

PATIENT'S NAME:___________________________________ MEDICAL DIAGNOSIS:_____________________________________________________
AGE:_______ AREA:___________
`
Nursing Diagnosis
Nursing Intervention
Assessment (indicate the (indicate the type of NSG. Nursing Goal (indicate if
(indicate if independent Rationale Evaluation
method used) Dx; WELLNESS, RISK short or long term goal)
and collaborative)
OR ACTUAL NSG. DX)

Prepared and Submitted by: Submitted to:

Student Name & Level:________________________________________ Clinical Instructor:_______________________________________