1. 10%) ) The Summary of assessed problems 1- Actual subjective problem list a- b- c- d- 2- Actual objective problem list a- b- c- d- 3- Potential risk for problem list a- b- c-

2. Diagnostic evaluation (10) Nursing Interventions for abnormal results (2) Result Interpretation (2) (2) Test value & test unit (2) Test classTest NameTest Date (2) Test/ major finding**Other Diagnostic Tests ( ECG, X-ray,U/S,etc) Reference of lab value interpretation: Page9

3. Medication Profile ( 10 % ) Specific Nursing implications ( 2 ) Major side effects ( 2) Indication for this Client ( 2 ) Dose/Route/ Frequency ( 2 ) Drug major class ( 2 ) Drug name Intravenous Fluids/ additives Rate of flow page 10

4. Nursing Care- Plan 50% Note : Three Nursing Diagnoses are required Evaluation with Rationale ( 3 ) Actual intervention (3) Planned intervention & Rationale (12) Short-term goal (9) Evidenced by (9) Nursing (9) Diagnosis Priority ( 2) Functional Health Pattern (3) Page 11