RLE 002

Cebu Normal University

College of Nursing
Cebu City
Mission-Vision: Care Using Knowledge and Compassion
Theory-based (Betty Neuman)

NURSING CARE PLAN

Assessment
Diagnosis

3 points
3 points

Goals
Theoretical Basis

2 points
2 points

Name of Student:__________________________________________
Clients Initials:___________________________________________
Age:______Gender: _____Civil Status:________Religion:_______
Allergies: ________________________________________________
Diet:_____________________________________________________
Date of Admission:________________________________________
Diagnosis/Impression:_____________________________________
lifespan)

NURSING DIAGNOSIS
Assessment
Subjective:

Diagnosis

Interventions
Evaluation

4 points
1 point

Bibliography
15 points

Stressor Classification: (Please check)

______ Physiological (body structure and functions)
______ Psychological (mental processes and emotion)
______ Socio-cultural (relationships, social expectations)
______ Spiritual (influence of spiritual beliefs)
______ Developmental (developmental processes over the

NURSING GOALS

NURSING OUTCOME

Mutual Planning

Interventions

(Goal attainable within the

shift)

(with Rationale & Source)

PRIMARY INTERVENTIONS
Promotive:

Objective:

Preventive:

Actual Evaluation

Theoretical basis:

SECONDARY INTERVENTIONS
Curative

TERTIARY INTERVENTIONS
Rehabilitative

Bibliography: