Nursing Careplan Sheet

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Nursing Care Plan Sheet (Suggested Form)
Date: Resident's Name: RN Name Resident's Link # Medical Diagnosis:

Assessment NANDA
Nursing Diagnosis (copy and paste from NNN Linkages or, see NANDA):
Definition of diagnosis (copy and paste from NNN Linkages or, see NANDA): Subjective Data Objective Data

Planning NOC
Goals: Definitions for each outcome (copy and paste from NNN Linkages or, see NOC):

Nursing Activities NIC
Nursing Intervention Group (checkmark) (see chart below): 1. Physiological: Basic (Classes A-F) 4. Safety (Classes U-V) 2. Physiological: Complex (Classes G-N) 5. Family (Classes W, X, Z) 3. Behavioral (Classes O-T) 6. Health System (Classes Ya-Yb) 7. Community (Classes Yc-Yd)

Definitions for each intervention (copy and paste from NNN Linkages or, see NIC): Signature of RN Review of Nursing Care Plan

Date 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Annual

References (APA style)

Name_________________________________________D.O.B.________________

NIC Groups
1 A Physiological: Basic. Activity & Exercise Mgt. Elimination Mgt Immobility Mgt Nutrition Support Physical Comfort Promotion Self-Care Facilitation 2 G Physiological: Complex Electrolyte & Acid-Base Mgt. Drug Mgt 3 O Behavioral Behavior Therapy Cognitive Therapy Communication Enhancement Coping Assistance Patient Ed. 4 U Safety Crisis Mgt Risk Mgt 5 W Family Childbearing Care Childrearing Care Lifespan Care 6 Y Health System Health System Mediation Health System Mgt Information Mgt 7 Yc Community Community Health Promotion Community Risk Mgt

B

H

P

V

Z

Ya

Yd

C D E

I J K

Neurological Mgt Perioperative Care Respiratory Mgt

Q R S

X

Yb

F

L

Skin/Wound Mgt

T

Psychological Comfort Promotion

M N

Thermoregulation Tissue Perfusion Mgt

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