Nutrition/Hydration
Patient Information
(1)
Name:
Age:
Gender:
Code Status:
DPOA:
Living Will:
Cultural considerations, ethnicity, occupation, religion, family support, insurance. (1) (14) Socioeconomic/Cultural/Spiritual Orientation & Psychosocial Considerations/Concerns, to include the following Social Determinants of Health
❋Economic Stability ❋ Education
❋Social and Community Context ❋ Health and Health Care ❋ Neighborhood and Built Environment
Chief Complaint
Admitting Diagnosis
Medical Management/ Orders/ Medications & Allergies (2)
Erickson’s Developmental Stage Related to pt. & Cite References (1)
Patient Education (In Pt.) & Discharge Planning (home needs)
History of Present Illness (HPI), Pathophysiology of Admitting Dx (Cite References) Medical, Surgical, Social History (1).
Medical History
Surgical History
Social History
Diagnostic Test/ Lab Results with dates and Normal Ranges (3)
Concept Map
Student Name:
Instructor:
PC Outcomes/Goal
Priority nursing diagnosis #2
Respiratory (7)
Vital Signs (4)
Integumentary (12)
Interventions # 2
Assessment/ Evaluation #1
Assessment/ Evaluation #2
PC Evaluation Plan
Potential Complications/ at risk for
PC Interventions
Psychosocial (14)
Cardiovascular (6)
Endocrine (13)
Misc. (Ht/Wt)
GU (10)
GI (9)
Nutrition/Hydration
(8)
Rest/ Exercise (11)
Neurological (5)
Outcome/Goal #1
Priority nursing diagnosis #1
Outcome/Goal #2
Interventions #1
