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NURS 2910
Plan of Care Evaluation

Student Name: ___________________________________
Week#: ___________________

Date: ________________________

Faculty: ______________________________________________

Instructions: Attach a copy of this form to each of you Clinical Plan of Care/Maps for grading purposes.
Sections:
1.

2.

3.

4.

5.

6.
7.
8.
9.

Patient Data includes:
10 points possible ______
a. Physical data
b. Health history
c. All blanks and/or issues are addressed
Lab and Diagnostic Test Data:
10 points possible ______
a. Test and results
b. Rationale for the patient
c. Nursing implications and teaching
Each medication includes:
20 points possible ______
a. Name
b. Rationale
c. Side effects
d. Nursing implications and teaching
Problem Identification includes:
20 points possible ______
a. Correctly lists individualized needs
b. Correctly identifies problems
c. Problems are prioritized and numbered each problem in priority of importance
d. Map includes at least three physiological problems, psychosocial/spiritual issues, discharge
planning and patient education(more towards end of semester)
e. Each problem includes:
i. Nursing diagnosis
ii. Data to support
iii. Medication
iv. Nursing treatment (interventions)
Planned interventions includes:
10 points possible ______
a. Interventions appropriate
b. Correctly prioritizes interventions
c. Assessments performed
d. Communication
e. Patient teaching
f. Discharge planning
Evaluation of Interventions includes:
10 points possible ______
a. Evaluates physical interventions
b. Evaluates teaching
Critical Assessments are appropriate to Dx:
10 points possible ______
a. Document focused assessment
Overall Care Map:
a. Neatness/readable by faculty
5 points possible ______
b. Complete
SOAP Note
5 points possible_______

Comments:
Total Points _______________/100 = ________%

0


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