Impaired Home Maintenance Management

Published on Saturday March 10th , 2007

Impaired Home Maintenance Management

(_)Actual (_) Potential

**Related To:**
*[Check those that apply]*
Chronic debilitating disease: (_) Arthritis (_) Cancer (_) CHF (_) COPD (_) Diabetes mellitus (_) Multiple sclerosis (_) Muscular dystrophy	Injury to individual or family members: (_) Addition of family member (_) Loss of family member (_) Impaired mental status (_) Insufficient finances (_) Lack of knowledge (_) Substance abuse (_) Surgery (_) Unavailable support system (_) Other:_____________________________ ____________________________________ ____________________________________

**As evidenced by:**
*[Check those that apply]*
Major: (Must be present)	(_) Outward expressions by individual or family of difficulty in maintaining the home or in caring for self or family members.
Minor: (May be present)	(_) Poor hygiene practice. (_) Unwashed cooking/eating utensils. (_) Impaired caregiver. (_) Inadequate support system.

Date &
Sign.

Plan and Outcome
[Check those that apply]

Target
Date:

Nursing Interventions
[Check those that apply]

Date
Achieved:

The patient or caregiver will:

(_) Identify factors that restrict self care and home management.

(_) Demonstrate the ability to perform skills necessary for the care of the individual or home.

(_) Express satisfaction with home.

(_) Other:

(_) Assess for factors that might impair home management.

(_) Explore with patient and/or significant other, factors that will facilitate home management and provide appropriate health teaching. (See Discharge Plan)

(_) Procure necessary equipment or aids:____________________
________________________
________________________

(_) Refer to/consult with appropriate agencies for:

insufficient funds:
cooking:
transportation:
housework:
home maintenance:
other:

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

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