Free Printable Nursing Care Plan Template
Printable Nursing Care Plan
Prepared by: [YOUR NAME]
Email: [YOUR EMAIL]
Patient Information
|
Patient Name |
Patient ID |
Date of Admission |
Date of Plan Creation |
Plan Review Date |
|---|---|---|---|---|
|
Alanis Durgan |
12345 |
January 10, 2051 |
January 12, 2051 |
January 19, 2051 |
Assessment Data
Primary Medical Diagnosis: Diabetes Mellitus Type 2
Nursing Diagnosis: Imbalanced Nutrition: More Than Body Requirements, related to poor dietary habits as evidenced by BMI of 32 and fasting blood glucose of 250 mg/dL.
Goals and Outcomes
|
Goal |
Target Date |
Desired Outcome |
|---|---|---|
|
Achieve blood glucose levels < 150 |
February 15, 2051 |
Patient maintains fasting glucose in the target range. |
|
Reduce weight by 5% |
March 15, 2051 |
BMI reduced to < 30. |
Interventions
|
Intervention |
Frequency |
Responsible Party |
Notes |
|---|---|---|---|
|
Educate patient on a low-carb diet |
Weekly |
Registered Nurse |
Provide dietary pamphlets. |
|
Monitor fasting blood glucose levels |
Daily |
Nursing Staff |
Record levels in patient log. |
|
Encourage 30 minutes of walking per day |
Daily |
Physical Therapist & Patient |
Set achievable milestones. |
|
Schedule follow-up with a dietitian |
February 1, 2051 |
Nursing Administration |
Confirm appointment details. |
Evaluation
|
Intervention |
Outcome Achieved? |
Follow-Up Actions Required |
Date Evaluated |
|---|---|---|---|
|
Educate patient on a low-carb diet |
Yes |
Continue monitoring progress |
January 19, 2051 |
|
Monitor fasting blood glucose levels |
In Progress |
Review daily logs with patient |
January 19, 2051 |
|
Encourage 30 minutes of walking daily |
Partial Compliance |
Adjust milestones if necessary |
January 19, 2051 |
