CNU-CN FORM 002

Cebu Normal University

College of Nursing
Cebu City

Mission-Vision: Care Using Knowledge and Compassion

NURSING CARE PLAN

NCP Scoring System 10 pts Defining Characteristics 3 pts Intervention 3 pts
Nursing Dx 2 pts Outcome 1 pt Bibliography 1 pt (at least 5 references)

Client’s Name: __________________________________________________________________ _______________________________________________________________________________

Age: _____ Sex: _____ Status: _______________________ Religion: _____________________
Allergies Food: ________________________________________________________________
Drug: ________________________________________________________________
Diet: ___________________________________________________________________________
Date of Admission: ______________________________________________________________
Diagnosis:
______________________________________________________________________
Patient Care Classification: (please check)
_______ Wholly Compensatory: Pts therapeutic self-care is accomplished by nurse
_______ Partially Compensatory: Pts perform some self-care measures
_______ Supportive Educative: Pts accomplishes self-care measures
Clinical Division and Bed No: _______________________________________________
Name of Physician: _______________________________________________________
Name of Student: _________________________________________________________

Expected Outcome Criteria Behavioral Outcome

Defining Characteristics Intervention and Rationale
(Ideal) (Actual)
Nursing Diagnosis Short term: Independent

S:

O: Long term:
 Defining Characteristics Expected Outcome Criteria Intervention and Rationale Behavorial Outcome
(Ideal) (Actual)
Laboratory

Theoretical Basis

Dependent/Collaborative