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Alteration in Health Maintenance
Alteration in Health Maintenance
(_)Actual (_) Potential
| (_) Loss
of independence (_) Changing support systems (_) Change in finances (_) Lack of knowledge (_) Poor learning skills (illiteracy) (_) Crisis situation (_) Inadequate health practice (_) Substance abuses:_______ __________________________ |
(_) Lack
of accessibility to health care services (_) Health beliefs (_) Religious beliefs (_) Cultural/folk beliefs (_) Alterations in self image (_) Age related conditions (_) Other:_____________________________ ____________________________________ ____________________________________ |
| Major:
(Must be present) |
(_) Reports or
demonstrates an unhealthy practice or life style. (_) Reckless driving of vehicle. (_) Substance abuse. (_) Overeating. (_) Reports or demonstrates frequent alterations in health. eg: _________________________________________________ |
| Date & Sign. |
Plan and Outcome [Check those that apply] |
Target Date: |
Nursing Interventions [Check those that apply] |
Date Achieved: |
| The
patient will: (_)
Incorporate principles of health promotion into
lifestyle: (_) Other: |
(_)
Assess for factors that contribute to the promotion and
maintenance of health or that result in alterations in
health. (_)Provide pertinent information concerning screening for: breast cancer, BP, other:______________________ (_) Explore health promotion behaviors that patient is willing to incorporate into lifestyle. (_) Initiate health teaching and referrals as indicated:
(_)
Other:________________ |
__________________________
Patient/Significant other signature
__________________________
RN signature
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