Students Name: Facility: Primary Dx: Nursing Diagnosis (Priority 1): Related to: As evidenced by: Short term

goal/expected outcome: Long term goal/expected outcome:

Prioritize Interventions (List in order of highest priority. You should have a minimum of 5 interventions.)

BOWIE STATE UNIVERSITY Department of Nursing Pediatric Care Plan Spring 2011 Instructors Name: Unit: Secondary Dx:

Date: Patients Age: Reason for Admission:

Rationale for Interventions with citation: (McCoy, 2011) Include full citation on Reference page with grading criteria.)

Evaluation (Actual or what you would you would have evaluated if you had more time to spend with the patient.)

1. 2. 3. 4. 5. 6. 7. 8.

BOWIE STATE UNIVERSITY Department of Nursing Pediatric Care Plan Spring 2011 Nursing Diagnosis (Priority 2): Related to: As evidenced by: Short term goal/expected outcome: Long term goal/expected outcome:
Prioritize Interventions (List in order of highest priority. You should have a minimum of 5 interventions.) Rationale for Interventions with citation: (McCoy, 2011) Include full citation on Reference page with grading criteria.) Evaluation (Actual or what you would you would have evaluated if you had more time to spend with the patient.)

1. 2. 3. 4. 5. 6. 7. 8.

BOWIE STATE UNIVERSITY Department of Nursing Pediatric Care Plan Spring 2011 Nursing Diagnosis (Priority 3): Related to: As evidenced by: Short term goal/expected outcome: Long term goal/expected outcome:
Prioritize Interventions (List in order of highest priority. You should have a minimum of 5 interventions.) Rationale for Interventions with citation: (McCoy, 2011) Include full citation on Reference page with grading criteria.) Evaluation (Actual or what you would you would have evaluated if you had more time to spend with the patient.)

1. 2. 3. 4. 5. 6. 7. 8.