Impaired Adjustment

Impaired
Adjustment

(_)Actual (_)
Potential

Related
To:
[Check
those that apply]
(_)
Illness
(_) Other:_____________________________
____________________________________

____________________________________

 

As
evidenced by:
[Check
those that apply]
Major:

(
Must be
present
)
(_)
Verbalization of non-acceptance of health status change.
(_) Inability to be involved in problem solving or goal
setting.
Minor:

(
May be
present
)
(_) Lack
of movement toward independence.
(_) Extended period of shock, disbelief, or anger
regarding health status change.

(_) Lack of future oriented thinking.

 

Date &
Sign.
Plan and Outcome
[Check
those that apply]
Target
Date:
Nursing Interventions
[Check
those that apply]
Date
Achieved:
  The
patient will:

(_)
Identify the temporary and long term demands of the
situation.

(_) Differentiate
coping behavior that is effective vs. ineffective.

(_) Other:

  (_)
Asses the patient’s:
  • pre-morbid
    lifestyle
  • pre-morbid coping
    style
  • amount and type
    of resources available
  • extent of current
    disruption on life style
  • current level of
    stress
  • current coping
    methods and their effectiveness

(_) Assist patient to
identify the stressors.

(_) Explore feelings
about situation with patient.

(_) Identify factors
that interfere with or delay effective adjustment:

  • unmanageable
    level of stress
  • ineffective
    problem solving
  • inadequate or
    unavailable resources
  • significant
    other(s)
  • inadequate coping
    mechanisms
  • explore effective
    coping mechanisms

(_)
Other:________________
________________________
________________________

________________________

 

 

__________________________
Patient/Significant other signature

 

__________________________
RN signature