Roane State Community College

Nursing Program
Pediatric Nursing Care Plan

Student: Date:

Patient's Initials : Age Group: Date of Admission:

Age: Sex: Diagnosis:
Height: Weight: Surgery:
Allergies: Date of Surgery:
Past Medical/Surgical History: Include previous illnesses and/or Current Hospitalization: Signs and symptoms description, definition and
hospitalizations: medical/surgical management of diagnosis.

Social/cultural information: Include family members, religion, culture, Lab data, x-rays, tests: Interpret abnormal values and nursing
medical insurance, school attendance, etc. implications related to abnormal findings.
 PEDIATRIC NURSING CARE PLAN

Immunizations: Identify recommended Vitals: Treatments:

immunizations for specific ages and indicate if Identify normal vitals for age of your patient Why indicated - Expected outcomes:
immunizations are current for this child. and significant deviations in your patient.

Growth & Development: Be specific: State normal growth and development for age and compare this child with normals.
Identify what effects the illness/hospitalization has had on normal growth and development
 Roane State Community College
Pediatric Nursing Care Plan

Maslow's Needs Assessment: Assessment: Nursing Patient Goals/ Nursing Rationale & Evaluation/
Subjective Objective Data Diagnosis Outcome Interventions/ Reference Actual Outcome
Data Priority: Criteria Nursing Orders
 Roane State Community College
Pediatric Nursing Care Plan
Maslow's Needs Assessment: Assessment: Nursing Patient Goals/ Nursing Rationale & Evaluation/
Subjective Objective Data Diagnosis Outcome Criteria Interventions/ Reference Actual Outcome
Data Priority: Nursing Orders
 Roane State Community College
Pediatric Nursing Care Plan

Maslow's Needs Assessment: Assessment: Nursing Patient Goals/ Nursing Rationale & Evaluation/
Subjective Objective Data Diagnosis Outcome Criteria Interventions/ Reference Actual Outcome
Data Priority: Nursing Orders
 Roane State Community College
Pediatric Nursing Care Plan

Maslow's Needs Assessment: Nursing Diagnosis Patient Goals/ Nursing Rationale & Evaluation/
Subjective Data Priority: Outcome Criteria Interventions/ Reference Actual Outcome
and Objective Data Nursing Orders
(Designate Which)