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Your paper must follow APA guidelines Title slide: please include title of RUA, your name, name of school, number and name of course, instructor

September 21, 2024

Your paper must follow APA guidelines

Title slide: please include title of RUA, your name, name of school, number and name of course, instructor name, due date or session.
All information should be on its own line and centered.-FOLLOW APA GUIDELINES!
Please delete the highlighted areas when submitting, this is only for your reference.

Assessment

Highlight key areas of concern

General appearance:

Vitals:

Neuro:

HEENT:

Cardiac:

Respiratory:

GI:

GU/Elimination:

Integumentary:

Musculoskeletal:

Psychosocial:

Labs/Diagnostics:

Pathophysiology (include what functional changes are occurring and what processes or issues initiated, lead, and are maintaining the disorder/disease)

Pertinent Medical diagnoses/Reason for hospitalization:

Student name: ______________________

Date: ______________________

Client initials:__________ Age: ________________

Male/Female/Nonbinary

High priority NANDA diagnosis

NANDA diagnosis

Psychosocial NANDA diagnosis

Short term (ST) goal:

Long term (LT) goal:

Short term(ST) goal:

Long term (LT) goal:

Short term (ST) goal:

Long term (LT) goal:

ST interventions

LT interventions

ST interventions

LT interventions

ST interventions

LT interventions

Evaluation

Linkages and Rationale of Diagnosis

Short summary rationale for why these diagnosis were chosen and how they connect to the client’s current situation/condition

Rationale for why goals were selected

Should have a rationale for each short- and long-term goal. Provide references as applicable

Infection control:

Safety:

Communication:

References:

>Nursing homework help

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