Disuse Syndrome
Disuse Syndrome
(_)Actual (_) Potential
| (_)
Unconciousness (_) Neuromuscular Impairment (_) Musculoskeletal condition (_) Immobility (_) Traction/casts/splints (_) Other:_____________________________ ____________________________________ ____________________________________ |
| Major:
(Must be present) |
(_) Presence of risk factors. (See above "Related To"). |
| Date & Sign. |
Plan and Outcome [Check those that apply] |
Target Date: |
Nursing Interventions [Check those that apply] |
Date Achieved: |
| The
patient will: (_) Maintain or regain free range of motion of extremities within limits of disease. (_) Maintian or regain
function of:___________ (_) Other: |
(_)
Assess range of motion of affected extremities and the
ability of patient to perform ADL's. (_) Consult with PT/OT regarding necessary exercises/assistive devices. (_) Range of motion to____________ extremities ____________ times a day. (_) Splints to _________________. Apply during __________. Remove for _______________. (_)
Other:________________ |
__________________________
Patient/Significant other signature
__________________________
RN signature
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