aide care plan clinician: mileage: gender: aide frequency ... · pdf fileaide care plan...

Aide Care Plan Functional Limitations Activities Permitted Amputation Paralysis Legally Blind Bowel/Bladder Incontinence Page 1 of 1 Aide Care Plan Hearing Endurance Other: Dyspnea Contracture Ambulation Speech Other: DME Blood Pressure Pulse Respiration Temperature Weight Bedside Commode Cane Elevated Toilet Seat Grab Bars Hospital Bed Nebulizer Oxygen Tub/Shower Bench Walker Wheelchair Supplies Other: ABDs Ace Wrap Alcohol Pads Chux/Underpads Diabetic Supplies Drainage Bag Dressing Supplies Duoderm Exam Gloves Foley Catheter Gauze Pads Insertion Kit Irrigation Set Irrigation Solution Kerlix Rolls Leg bag Needles NG Tube Probe Covers Sharps Container Sterile Gloves Syringe Tape Complete Bed Rest Up as Tolerated Exercise Prescribed Independent at Home Cane Bed Rest with BRP Transfer Bed-Chair Vital Signs Partial Weight-Bearing Crutches Wheelchair Walker Vital Sign Notification BP Systolic Pulse BP Diastolic Temperature No Bowel Movement in 3 Days Foley: Weight Gain or Loss > < > < > < Respiration > < > < Elimination Activity Assist w/ Bed Pan Assist w/ Bedside Commode Catheter Care Empty Ostomy Bag Incontinent Care Record Bowel Movement Assist in Ambulation Assist in Transfer Range of Motion Turn or Position Assist to Dress Back Rub/Massage Check Pressure Areas Comb Hair Complete Bath Foot Care Nail Care Oral Hygiene Denture Care Partial Bath/Sponge Pericare Shampoo Hair Shave Skin Care Tub/Shower Universal Precautions Additional Comments: Signature & Title Date: Frequency Household Change Linen Light Housekeeping Make Bed Frequency Frequency Frequency Frequency Frequency Personal Care Clinician: M F Aide Frequency: Patient Name (Last Name, First Name) & MRN: Gender: Agency Name/Branch: Mileage: © 2010-2011 Kinnser Software, Inc. All rights reserved.

Upload: vanminh

Post on 03-Feb-2018

215 views

Category:

Documents

1 download

Report

Download

Embed Size (px):

TRANSCRIPT

Aide Care Plan

Functional Limitations

Activities Permitted

Amputation Paralysis Legally Blind Bowel/Bladder Incontinence

Page 1 of 1Aide Care Plan

HearingEndurance

Other:Dyspnea Contracture Ambulation Speech

Other:

DME

Blood Pressure

Pulse

Respiration

Temperature

Weight

Bedside Commode Cane Elevated Toilet Seat Grab Bars Hospital Bed Nebulizer Oxygen Tub/Shower Bench Walker Wheelchair

Supplies

Other:

ABDs Ace Wrap Alcohol Pads Chux/Underpads Diabetic SuppliesDrainage Bag Dressing Supplies Duoderm Exam Gloves Foley Catheter Gauze Pads Insertion Kit Irrigation Set Irrigation Solution Kerlix Rolls Leg bag Needles NG Tube Probe Covers Sharps ContainerSterile Gloves Syringe Tape

Complete Bed Rest Up as Tolerated Exercise Prescribed Independent at Home Cane Bed Rest with BRP Transfer Bed-Chair

Vital Signs

Partial Weight-Bearing Crutches Wheelchair Walker

Vital Sign NotificationBP Systolic Pulse

BP Diastolic Temperature No Bowel Movement in 3 Days

Foley: Weight Gain or Loss

> <

> < Respiration > <

> <

Elimination

Activity

Assist w/ Bed Pan