SAINT PAUL UNIVERSITY DUMAGUETE

COLLEGE OF NURSING
NURSING CARE PLAN FORM

IN PARTIAL FULLFILMENT OF THE REQUIREMENT IN

_______________________________________

SUBMITTED TO:

________________________________________

SUBMITTED BY:

__________________________________________

DATE:

___________________________

Patient’s Name (Initials): C.T. Admitting Diagnosis/Medical Diagnosis/CC: Acute Ruptured Appendicitis
 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING
NURSING CARE PLAN FORM

Age: 19 Sex: F Physician (Initials): _________________________

Room No: ____________ Diet: ____________________________________

SUBJECTIVE OBJECTIVE NURSING DIAGNOSIS SCIENTIFIC ANALYSIS PLANNING INTERVENTIONS RATIONALE EXPECTED OUTCOME

“Di nako kasuot Vital signs: Disturbed body Nonverbal That after 8 Independent: Independent:  Patient
ug mga bikinis T- image r/t response to hours of nursing  Assess the  Adolescent verbalize
tungod sa akong P- surgical incision actual or interventions the result of s and d relief
tahi ma’am.” As R- as evidenced by perceived change patient will be body image young of
verbalized by the verbalization of in structure and able to: disturbanc adults may
BP- anxiety
patient. feelings that or function, e in be
alters her view verbalization of individual and
 Verbalize relation
 Irritab in her body’s feelings that ly adaptatio
relief of to the
le appearance reflect an anxiety and patient’s affected n to
 Anxious altered view of adaptation developmen by changes actual/
Definition: one's body in to tal stage. in the altered
Confusion in appearance, actual/alte  Evaluate structure. body
mental picture of structure, or red body the  There is a image.
one’s physical function, image. patient’s broad  Patient
self. verbalization of  Verbalize behavior range of verbalize
perceptions that acceptance regarding behaviors d and
Source: reflect an of self in the actual associated
Doenges, Marilynn altered view of with body
understoo
situation. or
E., Moorhouse, one's body in image d the
perceived
Mary Frances, appearance, changed disturbanc acceptanc
Murr, Alice C., structure, or body part e, ranging e of self
Nurse's Pocket function, or from in
Guide. 14th ed., behaviors of function. totally situation
Philadelphia, avoidance,  Evaluate ignoring .
Pennsylvannia, monitoring, or the the
F.A DAVIS acknowledgment of patient’s altered
COMPANY, 2016. one's body. verbal structure
remarks or
Source: about the function
Disturbed Body actual or to
Image, Nsc- perceived preoccupat
ultimatex.blogspo change in ion with
t.com body part it.
 Negative
SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING
NURSING CARE PLAN FORM

or statements
function. about the
 Acknowledg affected
e and body part
accept may
expression indicate
of limited
feelings ability to
of integrate
frustratio the change
n, into the
dependency patient’s EVALUATION
, self-
anger, gri concept.
ef, and
hostility.  Acceptance
of these
 Be feelings
realistic as a
and normal
positive response
during to what
treatments has
, in occurred
health facilitate
teaching, s
and in resolution
setting .
goals
within  This
limitation enhances
s. trust and
rapport
between
patient
and nurse.

 Provide  This
SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING
NURSING CARE PLAN FORM

hope promotes
within positive
parameters attitude
of and
individual provides
situation; opportunit
do not y to set
give false goals and
reassuranc plan for
e. future
based on
reality.

Dependent: Dependent:
 Assist  Promotes
client and continuati
SO to on of
incorporat program.
e
therapeuti
c regimen
into
activities
of daily
living.
SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING
NURSING CARE PLAN FORM

 Identify/p  To
lan for accommodat
alteration e
s to home individual
and work needs and
environmen support
t/activiti independen
es. ce.

Collaborative: Collaborative:
 Refer to  These are
physical helpful in
and identifyin
occupation g
al ways/devic
therapy, es to
vocational regain and
counselor, maintain
psychiatri independen
c ce.
counseling Patient
, clinical may need
specialist further
or assistance
psychiatri to resolve
c nurse, persistent
social emotional
services, problems.
and
psychologi  To
st, as determine
SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING
NURSING CARE PLAN FORM

needed. coping
 Determine abilities
individual and
/family/co skills.
mmunity
resources.

.
SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING
NURSING CARE PLAN FORM
SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING
NURSING CARE PLAN FORM
SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING
NURSING CARE PLAN FORM