STUDENT’S IDENTIFICATION

Name of the Institute : -INSTITUTE FO NURSING EDUCATION,

BYCULLA, MUMBAI- 08.

Name of the Student : - MR. VISHRAM SHRIDHAR KULKARNI

Batch : -FIRST YEAR M. Sc. NURSING

Name of Clinical area : -INTENSIVE CORONARY CARE UNIT

Duration of Clinical Experience : -28.10.2013 TO 31-10-2013

Date of Selection of Patient : -28.10.2013

Supervisor : - MRS. REGINA A. DIAS

Submitted to : - MRS. REGINA A. DIAS

1. PATIENT’S BIODATA:

Name : -Mr.Anand Vishnu Sutar

Address : -106, RukminiAppt, Birla College Road, Near Birla College, Milind Nagar,
Chikanghar, Kalyan, Dist. Thane

Age : -63 Years

Sex : - Male

Religion : -Hindu

Marital status : -Married

Occupation : - Carpenter

Date of admission : -21.10.2013

Unit In charge : -Dr. Anil kumar

Ward No. : -Intensive Coronary Care Unit

Registration No. : -1459120

Provisional Diagnosis : -Extensive Anterio-lateral myocardial infarction

Final diagnosis : - Left Ventricular Failure

Surgery if any : ----------

2. HISTORY OF ILLNESSES
History of Present Illness

 Onset : -Acute
 Presenting Complaints/
 Symptoms : -Chest pain -Squeezing , Throbbing
Sweating Breathlessness, Dyspnoea, Orthopnoea, Restlessness

 Duration : -10-30 min.

 Precipitating/Predisposing factors: -Hypertension since 2 years

Diabetes mellitus since 2 years

History of Past Illness

 Medical : -Hypertension since 2 years, off treatment since 7 months
 Surgical : - No history of any minor/major
 Any other : -No history of any other illnesses
 Allergies : -No history of any food, drug or other allergies
 Immunizations : -Not known
 Medications : -Was on antihypertensive & anti-diabetic medications
o Tab. Envas 2.5mg OD
o Some of the oral hypoglycemic drug which patient use to tale twice
daily before meals

4. FAMILY HISTORY

Type of family : -( Joint / Nuclear)

Sr. Name of family Relation Age/ Education Health Occupation Income
No members With Sex status
patient
1 Anand Vishnu Sutar Self 63yrs/ 4th AMI Carpenter Not
Male working
2 Mrs.Kamini A. Sutar Wife 58 yrs/ - Good Housewife _
Female

3 Mr.Sharad A Sutar Son 39 Yrs/ B.A. Good Carpenter To be

Male verify

4 Mr.Rohini S. Sutar Daughter 34 Yrs/ 12 th Good Housewife -

in Law Female

5 Master Sanket S. S. Grandson 6Yrs 1stStd Good Student _

 Genogram: -

KEYS

-Male

-Female

-Patient
  History of Illness in family members: -
No history of any illnesses in the maternal or paternal family members

 Risk factors: -
History of Hypertension since 2 years
History of Diabetes since 2 years

 Congenital Problems
No history of any congenital anomalies

 Psychological Problems
No any history of any psychiatric disorder

5. ECONOMIC STATUS

Monthly income : -Rs. 18000/month

Expenditure on health : -They have spent significant amount for treatment of hypertension.

Marital status : -Married &having happy married life.

6. PSYCHOLOGICAL STATUS:
 Ethnic/Cultural background: -
Believes all the Hindu cultural and religious beliefs, customs and tradition.
Celebrates all Hindu festivals & religious practices.

 Support system available: -

His wife and family.
7. PERSONAL HABITS
 Consumption of alcohol : -No
 Smoking : -No

 Tobacco chewing : -quit before 10 years

 Sleep : -Normal, sometimes disturbed, often due to polyuria

 Exercise : -No specific exercise

 Work : -Was working as a carpenter in Rajkamal studio, left the work

before 6 years

 Elimination : -Normal

 Nutrition : -Mixed diet ( Vegetarian and non-vegetarian occasionally)

8. PHYSICAL EXAMINATION
GENERAL APPEARANCE-
State of health - Average
Body build - Pyknic
Gait/posture - Normal
Body Movements - Reduced, can do minimal exertion
Hygiene and grooming - Average
Any gross abnormality - Nil
Activity - Diminished, having exertionaldyspnea..

MENTAL STATUS –
Consciousness - Conscious
Orientation - Fully oriented
Judgment - Intact
Memory - Good
Emotional status - Normal, showing satisfaction that he is out of danger
Affect - Appropriate
Mood - Euthymic
Insight - Normal

SKIN CONDITION-

Color - Fair
Texture - Normal
Turgor - Wrinkled
Lesion - Absent
Continuity - Intact

VITAL SIGNS –
Temperature - 98.2 F
Pulse - 68/min.
Respiration - 22/min.
Blood pressure - 140/90 mm of Hg

ANTHROPROMETRY

Height - 5’ 3”
Weight - 70 kg
Abdominal girth - 90cm

HEAD AND FACE

Symmetry - Symmetrical
Circumference - 55cm
Sign of trauma - Absent
Scalp - Normal
Hair - White n black
Face - Symmetrical, face skin is wrinkled.

EYES AND VISION-

Symmetry - Symmetrical
Eye brow - Normal
Eye lashes - Normal
Corneal reflex - Present
Conjunctiva - Normal, Pink
Sclera - White
Vision - Having short sightedness
Reactive to light - Pupils equally reactive to light
Discharge - Absent

EARS AND HEARING

Symmetry - Symmetrical
Discharge - Absent
Hearing acuity - Normal
Weber’s test - Not done
Renie’s test - Not done

NOSE

Symmetry - Symmetrical
Lesions - Absent
Discharge - Absent
Nostrils - Patent, septum intact, not deviated
Abnormality if any - Nil

ORAL CAVITY AND OROPHARYNX

Lips - Pink, dry, normal
Odor of mouth - Absent
Bleeding gums - Absent
Sore throat - Absent
Voice changes - Absent
Teeth - Normal, no caries, some brownish discoloration seen
Mucus membrane and gums - Normal, intact
Tongue - Pink, normal
Palate - Normal, no abnormality
Tonsils - Normal, not inflamed
Gag reflex - Present
Dysphagia - Absent

NECK

Symmetry - Symmetrical
Function of sternocleidomastoid muscles (Neck Flexion)- Present sometimes
Function of the trapezius muscles (side movement)- Absent
Lymph nodes - Not palpable
Stiffness - Absent
Swelling - Absent
Pain - Absent
Any other - Nil

BREASTS
Female
Symmetry -
Lump -
Discharge - Not applicable
History of breast disease /surgery -
Any other -

Male
Symmetry - Symmetrical
Lump - Absent
Swelling - Absent
Gynaecomastia - Absent
Any other - Nil

THORAX

Symmetry - Symmetrical
Size /shape - Normal
Chest movements - Normal
Breathing pattern - Normal
Cough - Absent at present

ABDOMEN

Symmetry - Symmetrical
Size and shape - Normal
Abdominal distension - Absent
Surgical mark - Absent
Bowel sounds - Present
Palpation (e.g. liver, spleen, bladder) - No organomegaly

EXTREMITIES
Upper extremities - Symmetrical
Symmetry

Lower extremities - Symmetrical

Symmetry

Power - 4 4

4 4

GENITALIA

Male
 Urinary complaints - Absent
Discharge - Absent
Any other - Nil

Female
LMP -
Vaginal discharge - Not applicable

Systemic Assessment
Sr.n System Assessment
o.
1 Nervous System
  feelings of anxiety, apprehension, Present

 tremors, Absent

 convulsions, history of psychiatric care, Absent

 changes in memory, changes in judgment, Absent

 pain, Absent

 parasthesia (numbness), paralysis, Absent

And coordination. .

 Musculoskeletal System- presence of muscular Absent

pain,

 swelling, Absent

 deformity, Absent

 disability or pain in joints, weakness,

Absent
 Atrophy and cramps.
Absent

DEEP TENDON REFLEXES

Right Left
 Biceps
++ ++
 Triceps
++ ++
 Patellar
++ ++
 Achilles
++ ++
 Planter

 Gluteal
++ ++

System Assessment

2 Respiratory System

 Auscultation Air entry equal on both sides, No rhails,

rhonchi, crept
  Palpation No lumps or lymph nodes palpable

 Percussion Resonance sounds

 Dyspnea,
Dyspnoea on exertion
 Orthopnea,
Absent
 Cough
(productive or nonproductive, and if productive, Absent
odor and color, amount of sputum),
 pain
Absent
 wheezing,
Absent
 hoarseness, Absent
 Strider (harsh or high-pitched respirations). Absent

 Breath sounds
1. Tracheal Normal

2. Bronchial Normal

3. Vesicular
Normal

Sr.n System Assessment

o

3 Cardiovascular system

 Exertional dyspnea, Present Class I-II (NYHA)

  paroxysmal nocturnal dyspnea, Absent

 Palpitations, syncope Absent

 chest pain Absent

 Vital Signs
80/min.
Pulse -
26/min
Respiration -
100/70 mm of Hg
Blood Pressure –

 Heart Sounds Left parasternal pan systolic murmur

present, S2 Loud
 angina
Absent

 myocardial infarction, Absent

 Varicosities, phlebitis and circulatory

problems in the extremities, particularly with Absent
exposure to cold (Reynaud’s), heart murmurs, etc.

Sr. System Assessment

no.

4 Gastrointestinal System

 changes in appetite, Absent

  complaints of dysphasia, Absent

 pyrosis, Heartburn Absent

Absent
 indigestion,
Absent
 nausea, vomiting,

 blood in stool or vomits,

Absent
 flatulence, Absent

 jaundice, Absent

 pain, Absent

 changes in bowel habits Absent

 constipation, Absent

 diarrhea,
Absent
 Hemorrhoids.
Absent

Sr. System Assessment

no.

5 Reproductive System

 Male
Absent
 Penis- discharge, ulceration, pain, size,

Normal
Scrotum - size, color, nodule, tenderness,
Normal
Testes - size, shape swelling, masses & absence

 Female-
Not applicable
Labia majora&minora, urethral & vaginal orifice,
discharge, swelling, ulceration, nodule, masses,
tenderness, pain, purities, pap smear, menstrual flow &
menopause

6 Musculoskeletal System

 Activity level- prescribed, actual, range of motion Diminished due to exertional dyspnoea

 Extremities- size, shape, symmetry, temperature,

No cyanosis, clubbing,
color, pigmentation, scar, hematoma, rash, ulceration,
Joint pain etc.
numbness, swelling, prosthesis & fracture
 Joints- active & passive mobility, stiffness, No joint pain, deformities
deformities, fixation, swelling, fluid, crepitation, pain
& tenderness
 Muscles- symmetry, size, shape, tone, weakness, Normal
cramps, spasm, rigidity
 Back- scar, spinal abnormalities, scoliosis, kyphosis,
Symmetrical, normal
lordosis, tenderness & pain

Sr. System Assessment

No

7 Genitourinary System
  frequency of urination, including urgency, Normal

 hesitation, Absent

 pain, blood, Absent

 absence or diminishing amount, pus, Absent

 color, and dribbling or incontinence; Absent

 and check for past or present evidence of Absent

sexually transmitted diseases (STD).

9. DISEASE CONDITION (Left Ventricular Failure)

Definition: -Heart Failure is a physiologic state in which the heart cannot pump enough blood to meet the
metabolic needs of the body (determined) as oxygen consumption.
 RELATED ANATOMY AND PHYSIOLOGY: -
The human heart is a four-chambered pump made up of two receiving chambers called atria and two
pumping chambers called ventricles.

Right Atrium (RA)

The Right Atrium receives oxygen-depleted blood returning from the body through the superior and inferior
vena cava. It is a thin walled, low-pressure system. Normal pressures in the Right Atrium are typically 0–8
mmHg. It is home to the Sino atrial, or SA Node, the pacemaker of the heart.

Right Ventricle (RV)

The Right Ventricle is also a thin walled, low-pressure chamber. It receives blood from the Right Atrium
when the atrioventricular valve dividing the Right Atrium and ventricle (the Tricuspid Valve) is open. When
this valve is open, and the chamber is resting (filling with blood [diastole]) typical right ventricular
pressures are equal to that in the Right Atrium, 0-8 mmHg. However, when the valve closes and contraction
(systole) begins, pressures are 15-25 mmHg, enough to pump blood forward to the lungs via the right and
left pulmonary arteries. The blood is then oxygenated in the lungs.

Left Atrium (LA)

Another thin walled, low-pressure chamber is the Left atrium. It receives oxygen-rich blood from the
pulmonary circuit, via the right and left pulmonary veins. Normal resting pressures (diastolic pressures) in
the Left atrium are 4-12 mmHg, less than that of the lungs. Because pressure is less in this chamber during
diastole, blood is more easily returned from the higher-pressure pulmonary circuit.

Left Ventricle (LV)

The Left Ventricle is a thick walled chamber that receives blood from the Left atrium, and is approximately
Three times thicker than the Right Ventricle. When the atrioventricular valve dividing the Left atrium and
Ventricle (the Mitral Valve) is open and the chamber is resting, or filling with blood (diastole) typical left
Ventricular pressures are equal to that in the Left atrium, 4-12 mmHg. However, when the valve closes and
Contraction (systole) begins; pressures must be generated to overcome the body’s systemic vascular
resistance (SVR). These pressures are typically 110-130 mmHg. When the ventricle generates enough
pressure to overcome the SVR, blood moves out the semilunar valve known as the Aortic Valve into the
aorta. There it is transported throughout the body via a network of arteries, capillaries, and veins. Eventually
the blood will return to the Right Atrium where the oxygenation process starts all over again.
Cardiac Output (CO)
About two-thirds of the atrial blood flows passively from the atria into the ventricles. When atrial
contraction occurs, the atrial blood is pushed down into the ventricles. This atrial contribution is called atrial
kick and accounts for approximately thirty present of the cardiac output.
Cardiac output is the amount of blood ejected by the Left Ventricle every minute. Cardiac output equals the
Stroke volume times the heart rate.
The heart rate is the number of times that the heart beats per minute. Heart rate increases or decreases based
Upon the metabolic and oxygen demands of the body. The stroke volume is the amount of blood pumped by
the heart per cardiac cycle. It is measured in ml/beat. A decreased stroke volume may indicate impaired
cardiac contractility or valve dysfunction and may result in heart failure. It may also indicate decreased
circulating volume. Increased stroke volume may be caused by an increase in circulating volume or an
increase in inotropy, the contractile force of the ventricle.

When the heart rate or the stroke volume (amount of blood ejected with each contraction) increases, cardiac
Output increases. When the heart rate or the stroke volume decreases, cardiac output decreases. Cardiac
output varies according to body mass, but is typically between 4-8 litters per minute.
Cardiac index is cardiac output normalized for body surface area. There are several methods for measuring
Cardiac output. Typical cardiac indices are between 2.5-4.0 litters of blood per minute per meter2.

Cardiac Valves
When blood flows through the heart, it follows a unidirectional pattern. There are four different valves
within the myocardium and their functions are to assure blood flows from the right to left side of the heart
and always in a “forward” direction. The two valves found between the atria and ventricles are
appropriately called atrioventricular (A-V) valves. The Tricuspid Valve separates the Right Atrium from the
Right Ventricle. The Tricuspid Valve is named so because of its three (tri) leaflets (cusps). Similarly, the
Mitral Valve separates the Left atrium from the Left Ventricle. The Mitral Valve is a two-leaflet valve,
named after a bishop’s miter. The two remaining valves are called semilunar valves (because they look like
half-moons). The valve located where the pulmonary artery meets the Right Ventricle is called the Pulmonic
Valve. The Aortic Valve is located at the juncture of the Left Ventricle and aorta. Both semilunar valves
prevent backflow of blood into the ventricles.
Cardiac Cycle
Correlation with Heart Sounds
The first heart sound is called S1 (The “Lub” of the “Lub-Dub” sound). It results from of closure of the
tricuspid and Mitral Valves during ventricular contraction. The second heart sound is called S2 (The “Dub”
of the “Lub- Dub” sound). It occurs at the end of ventricular contraction due to the closure of the Aortic and
Pulmonic Valves.

Heart Failure: -
Heart failure is a physiologic state in which the heart cannot pump enough blood to meet the
metabolic needs of the body (determined) as oxygen consumption.
Heart failure results from changes in systolic or diastolic function of the ventricle. The heart fails
when, because of intrinsic disease or structural defects, if cannot handle a normal blood volume or in the
absence of disease cannot tolerate a sudden expansion in blood volume (e.g. during exercise).
Heart failure is not a disease itself; instead, the term refers to a clinical syndrome characterized by
manifestations of volume overload inadequate tissue perfusion, & poor exercise tolerance. Whatever the
cause, pump failure results in hypo perfusion of tissues followed by pulmonary & systemic venous
congestion; it is often called congestive cardiac failure. Other terms denote heart failure include cardiac
decompensation, cardiac insufficiency and ventricular failure.
Terms used to describe cardiac function: -
1. Afterload: -Force that the ventricle must develop during systole to eject the stroke volume
2. Cardiac Output: - Stroke volume × heart rate
3. Inotropic state: - A measure of contractibility
4. Preload: - Stretch of myocardium at the end diastole
5. Stroke Volume: - The amount of Blood ejected from the ventricle with each contraction.

 Incidence: -

Heart failure affects about 5 million people with 5, 00,000 new cases diagnosed each year. In
contrast to decreases in mortality rates associated with other cardiovascular diseases the incidence
of heart failure & the mortality associated with it have increased steadily since 1975. Annually
about 300000 clients die from direct or indirect consequences of heart failure & the number of
deaths contributed to Heart Failure has increased 6 fold over the past 40 years.
  Risk factors: -
 Dysrhythmias, especially tachycardia
 Systemic infections
 Anemia
 Thyroid disorder
 Pulmonary embolism
 Thiamine deficiency
 Chronic pulmonary disease
 Medication dose changes
 Physical or emotional stress
 Endocarditis, myocarditis or pericarditis
 Fluid retention from medication or salt intake
 A new cardiac condition

 3) ETIOLOGY & RISK FACTORS : -

Sr. ACCORDING TO BOOK IN PATIENT
No

1. Idiopathic Present

2. Genetic predisposition Absent

3. Environmental e.g. exposure to drugs, alcohol Absent

etc.
 PATHOPHYSIOLOGY

NORMAL CARDIAC DEVELOPMENT

During the first month of gestation, the primitive, straight cardiac tube is formed, comprising the
sinuatrium (most cephalad), the primitive ventricle, the bulbuscordis, and the truncusarteriosus (most
caudad) in series. In the second month of gestation, this tube doubles over on itself to form two parallel
pumping systems, each with two chambers and a great artery. The two atria develop from the sinuatrium,
the AV canal is divided by the endocardial cushions into tricuspid and mitral orifices, and the right and left
ventricles develop from the primitive ventricle and bulbuscordis. Differential growth of myocardial cells
causes the straight cardiac tube to bear to the right, and the bulboventricular portion of the tube doubles over
on itself, bringing the ventricles side by side. Migration of the AV canal to the right and of the ventricular
septum to the left serves to align each ventricle with its appropriate AV valve. At the distal end of the
cardiac tube, the bulbuscordis divides into a sub aortic muscular conus and a sub pulmonary muscular
conus; the sub pulmonaryconus elongates and the sub aorticconus resorbs, allowing the aorta to move
posteriorly and connect with the left ventricle.
ABNORMAL DEVELOPMENT - VENTRICLES.

Partitioning of the ventricles occurs as cephalic growth of the main ventricular septum results in its
fusion with the endocardial cushions and the infundibular or conus septum. Defects in the ventricular
septum may occur because of a deficiency of septal substance; malalignment of septal components in
different planes preventing their fusion; or an overly long conus, keeping the septal components apart.
Isolated defects probably result from the first mechanism, whereas the latter two appear to generate the
VSDs in tetralogy of Fallot and transposition complexes.

During ventricular contraction, or systole, some of the blood from the left ventricle leaks into the
right ventricle, passes through the lungs and reenters the left ventricle via the pulmonary veins and left
atrium. First, the circuitous refluxing of blood causes volume overload on the left ventricle. Second, because
the left ventricle normally has a much higher systolic pressure than the right ventricle, the leakage of blood
into the right ventricle therefore elevates right ventricular pressure and volume, causing pulmonary
hypertension with its associated symptoms.
CLINICAL FEATURES

SR. ACCORDING TO BOOK IN PATIENT

NO.

10. INVESTIGATIONS

Date Investigation done Normal value Patient value Inference

16/09/13 Blood
Hemoglobin 12-16 gm.% 14.2 gm.% Normal
Total leucocytes count 4000-12000/mm3 7400/mm3 Normal
Platelets 1.5-4.5 lac/ mm3 3.37 lac/ mm3 Normal

Prothrombin time 1.08 Normal

 INR 1.08 Normal

Serum Biochemistry
Sodium 125-145 mEq/lit. 141 mEq/lit. Normal
Potassium 2.5- 4.5 mEq/lit. 3.8 mEq/lit. Normal
Urea 15-45 mg% 25 mg% Normal
Creatinine 0.8-1.2 mg% 0.8 mg% Normal

HIV Nonreactive Nonreactive Normal

HBsAg Nonreactive Nonreactive Normal

16/09/13 Arterial Blood Gas (ABG)

PH 7.35-7.45 7.36 Normal
P O2 80-100 mm of Hg 56.6 mm of Hg Hypoxia
P CO2 35-45 mm of Hg 36 mm of Hg Normal
HCO3 22-26 m Eq/lit. 20.5 mm of Hg Reduced
Interpretation : -

OTHER INVESTIGATIONS
2D- Echo Impression : -

Electrocardiogram (ECG) : -

Chest X-Ray: -

11.MEDICAL& SURGICAL MANAGEMENT

 a) Aim of the management
To treat the illness and to make him independent about his health.

Medical Management
 Inj. Dobutamine 2ml/hr.
 Inj. NTG 0.6 ml/hr
 Tab. Ecosprin 150mg od
 Tab. Clopitab 75mg BD
 Tab. Atorva 80mg HS
 Inj. Lasix 40 mg I/V BD

Surgical Management : -

12.COMPLICATIONS

SR. ACCORDING TO BOOK IN PATIENT

NO.
13.PROGNOSIS
15.NURSINGMANAGEMENT

Objectives of Nursing Care Plan: -

Needs Identified:-

1. Physical Needs:-
To promote comfort to the patient.
To promote rest and sleep.
To maintain proper hygiene and nutritional status.
To avoid physical exertion.
To assist the client in daily activities.
To maintain hygiene.
To prevent from debilitating complications.
To prevent edema& provide safety measures from skin excoriation.
2. Physiological needs:-
To maintain myocardial perfusion.
To reduce workload on heart.
To maintain adequate cardiac output.
To maintain/ meet the oxygen demands of the body parts.
To promote recovery.
To prevent infection.
To prevent complication.
To maintain nutritional status.
To plan surgery.

3. Psychological needs:-
To reduce anxiety & apprehension
To maintain psychological wellbeing
To avail the facilities for recreation
To allow relatives to meet when required.
To compliment effective communication.
To arise with coping strategies of the condition.
To give psychological support to the relative.
4. Emotional needs:-
To avoid stress & tension
To explain the patient about the investigation & procedures to be carried out.
To make patient familiar with the environment & instruments & equipment used in the care of the
patients.

To prepare the patients relative to accept the present disease condition and preparation of surgery or
further treatment.

5. Spiritual needs:-
To allows the relatives to perform the religious activities in the ward.
 -: Nursing Diagnoses: -

 Decreased Cardiac Output related to impaired contractility due to extensive heart muscle damage
 Impaired Gas Exchange related to pulmonary congestion due to elevated left ventricular pressures
 Ineffective Tissue Perfusion (renal, cerebral, cardiopulmonary, GI, and peripheral) related to
decreased blood flow
 Anxiety related to intensive care environment and threat of death
 Impaired skin integrity related to operative procedure as evidenced by dressing on chest.
 Acute pain related to surgical intervention as evidenced by child is crying.
 Impaired gas exchange related to ventilation as evidenced by the child is intubated and he is on
ventilator.
 Risk for ineffective breathing pattern Risk for poisoning, digitalis toxicity
 Deficient knowledge regarding condition, treatment plan, self-care, and discharge needs.
 Imbalanced nutrition more than body requirements related to pulmonary oedema as evidenced by
child is breathless.
 Ineffective coping related to uncertain future as evidenced by relatives are worried about the child’s
condition.

Summary

Conclusion: -
Health education on discharge-
Diet : -

Medication : -

Exercise : -

Follow – up : -

Any other : -
BIBLIOGRAPHY: -

REFERENCES: -
 NURSING CARE PLAN

Date: -

Assessment Nursing Objectives Plan of Action Nursing Interventions Rationale Evaluation

diagnosis
 NURSING CARE PLAN

Date: -

Assessment Nursing Objectives Plan of Action Nursing Interventions Rationale Evaluation

diagnosis
 NURSING CARE PLAN

Date: -

Assessment Nursing Objectives Plan of Action Nursing Interventions Rationale Evaluation

diagnosis
 NURSING CARE PLAN
Date: -
Assessment Nursing Objectives Plan of Action Nursing Interventions Rationale Evaluation
diagnosis
 NURSING CARE PLAN

Date: -

Assessment Nursing Objectives Plan of Action Nursing Interventions Rationale Evaluation

diagnosis
 NURSE’S NOTES
Patient’s name: - Diagnosis: -

Age: - Sex: - Ward No: - Bed No: - IPD No: - Unit In charge: -

Date of Admission: - / /

Signature of
Date Medication Diet Time Nursing observation & Intervention student
Nurse
 NURSE’S NOTES
Patient’s name: - Diagnosis: -

Age: - Sex: - Ward No: - Bed No: - IPD No: - Unit In charge: -

Date of Admission: - / /

Signature of
Date Medication Diet Time Nursing observation & Intervention student
Nurse
 DRUG STUDY
Drug trade name : - ___________________________ Pharmacological name: - ______________________________________

Dose Frequency: - ________________________________________________________________________________________

Side effects & Drug

Action Indications Nurse’s responsibility
Contra-indications interaction
DRUG STUDY
Drug trade name : - ___________________________ Pharmacological name: - ______________________________________

Dose Frequency: - ________________________________________________________________________________________

Side effects & Drug

Action Indications Nurse’s responsibility
Contra-indications interaction
 DRUG STUDY
Drug trade name : - ___________________________ Pharmacological name: - ______________________________________
Dose Frequency: - ________________________________________________________________________________________

Side effects & Drug

Action Indications Nurse’s responsibility
Contra-indications interaction
 DRUG STUDY
Drug trade name : - ___________________________ Pharmacological name: - ______________________________________

Dose Frequency: - ________________________________________________________________________________________

Side effects & Drug

Action Indications Nurse’s responsibility
Contra-indications interaction
 DRUG STUDY
Drug trade name : - ___________________________ Pharmacological name: - ______________________________________
Dose Frequency: - ________________________________________________________________________________________

Side effects & Drug

Action Indications Nurse’s responsibility
Contra-indications interaction