care plan format in mpu bhopal as per inc syllubus

1. MADHYANCHAL PROFESSIONAL UNIVERSITY
Ratibad, Bhopal (m.p.)
PATEL COLLEGE OF NURSING BHOPAL
SUBJECT:- CHILD HEALTH NURSING
Assignment on:- …………………………………
Remark:-……………………………………………
SUBMISSION ON
SUBMITTED TO SUBMITTED BY
MR. SATISH RINHAYAT
Assistant professor
(M.P.U)

2. CARE PLAN FORMAT
IDENTIFICATION DATA
Patient’s name :-
Father/husband name:-
Age/sex:-
Name of hospital:-
Ward name:-
Bed no:-
Education:-
Occupation
Marital status:-
Religion/caste:-
Address:-
Date of admission:-
Diagnosis:-
Consultant doctor:-
Chief complaints:-
HISTORY OF ILLNESS –
MEDICAL HISTORY
Present medical history :-
Past medical history:-
SURGICAL HISTORY
Present surgical history :-

3. Past surgical history:-
FAMILY HISTORY
S.NO. NAME OF FAMILY
MEMBER
AGE/SEX RELATION OCCUPATION HEALTH
STATUS
1.
2.
3.
4.
5.
6.
FAMILY TREE:-
ENVIRONMENTAL HISTORY
House:-
Locality :-
Electricity :-
Source of water:-
NUTRITIONAL HISTORY
Vegetarian / non-vegetarian:-
Like/dislike:-
Bed habit:-
Good habits:-

4. PHYSICAL EXAMINATION
General appearance
1. Nourishment:-
2. Body build:-
3. Health :-
4. Activity:-
Mental status
1. Conscious:-
2. Look :-
Posture
1. Body curve :-
2. Movement :-
Height & weight :-
Skin condition
1. Color :-
2. Texture:-
3. Temperature :-
4. Lesion :-
Head and face
1. Scalp :-
2. Face :-
Eye
1. Eyeball :-
2. Conjunctiva :-

5. 3. Sclera :-
4. Pupil :-
5. Vision:-
Ears
1. External ear :-
2. Tympanic membrane :-
3. Hearing :-
Nose
1. External nose:-
2. Nostril :-
Mouth and pharynx
1. Lips :-
2. Odor of mouth:-
3. Teeth:-
4. Gums:-
5. Tongue:-
6. Throat and pharynx :-
Neck
1. Lymph node:-
2. Thyroid gland :-
3. Range of motion :-
Chest
1. Thorax :-
2. Breath sound :-
3. Heart :-
Abdomens

6. 1. Observation :-
2. Percussion :-
3. Auscultation :-
4. Palpation :-
Back
Neurological test :-
VITAL SIGN
S.NO. PARAMETER PATIENTS VALUE NORMAL
VALUE
REMARK
1. Blood pressure
2. Temperature
3. Pulse
4. Respiration
5. Spo2

7. INVESTIGATION
S.NO. NAME OF INVESTIGATION PATIENTS VALUE NORMAL VALUE REMARK
OTHER INVESTIGATION:-

8. TREATMENT
S.NO. NAME OF
DRUG
ROUTE/DOSE FREQUENCY ACTION
FLUID

9. NURSING DIAGNOSIS
1.
2.
3.
4.
5.

10. CARE PLAN
ASSESSMENT DIAGNOSIS GOAL INTERVANTION IMPLIMENTATION EVALUATION
SUBJECTIVE
DATA:-
OBJECTIVE
DATA:-

11. ASSESSMENT DIAGNOSIS GOAL INTERVANTION IMPLIMENTATION EVALUATION
SUBJECTIVE
DATA:-
OBJECTIVE
DATA:-

12. ASSESSMENT DIAGNOSIS GOAL INTERVANTION IMPLIMENTATION EVALUATION
SUBJECTIVE
DATA:-
OBJECTIVE
DATA:-

13. ASSESSMENT DIAGNOSIS GOAL INTERVANTION IMPLIMENTATION EVALUATION
SUBJECTIVE
DATA:-
OBJECTIVE
DATA:-

14. ASSESSMENT DIAGNOSIS GOAL INTERVANTION IMPLIMENTATION EVALUATION
SUBJECTIVE
DATA:-
OBJECTIVE
DATA:-