Fillable Printable Nursing Care Plan Form
Fillable Printable Nursing Care Plan Form
Nursing Care Plan Form
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 outcom e
(cop y and paste from NNN Linkag es 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: Co mplex (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
Date
Review of Nursing Care Plan
1
st
Quar ter 2
nd
Quarter 3
rd
Quarter 4
th
Quarter Annual
References (APA style)
Name_________________________________________D.O.B.________________
NIC Groups
1 Physiological:
Basic.
2 Physiological:
Complex
3 Behavioral 4 Safety 5 Family 6 Health
System
7 Community
A Activity &
Exercise Mgt.
G Electrolyte &
Acid-Base Mgt.
O Behavior
Therapy
U Crisis
Mgt
W Childbearing
Care
Y Health
System
Mediation
Yc Community
Health
Promotion
B Elimination
Mgt
H Drug Mgt
P Cognitive
Therapy
V Risk
Mgt
Z Childrearing
Care
Ya Health
System
Mgt
Yd Community
Risk Mgt
C Immobility
Mgt
I Neurological Mgt
Q Communication
Enhancement
X Lifespan
Care
Yb Information
Mgt
D Nutrition
Support
J Perioperative
Care
R Coping
Assistance
E Physical
Comfort
Promotion
K Respiratory Mgt S Patient Ed.
F Self-Care
Facilitation
L Skin/Wound Mgt
T Psychological
Comfort
Promotion
M Thermoregulation
N Tissue Perfusion
Mgt
