Self
Care Deficit: Bathing
(_)Actual (_)
Potential
(_) Neuromuscular impairment (_) Visual disorders (_) Trauma or surgical procedure (_) External devices |
(_) Musculoskeletal disorders (_) Immobility (_) Nonfuntioning or missing limbs (_) Other:_____________________________ ____________________________________ |
Major: (Must be present) |
(_) Unable or unwilling to wash body or body parts. (_) Unable to obtain water. (_) Unable to regulate temperature or water flow. |
Date & Sign. |
Plan and Outcome [Check those that apply] |
Target Date: |
Nursing Interventions [Check those that apply] |
Date Achieved: |
The patient will: (_) (_) Demonstrate use of (_) Other: |
(_) Assess for causative factors. (_) Provide opportunities to relearn or (_) Teach patient to (_) Consistent bathing (_) Provide as much (_) Provide equipment (_) Encourage (_) Reinforce success (_) OT consult for:
(_) ________________________ |
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Patient/Significant other signature
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RN signature