Self Care Deficit: Bathing

Self
Care Deficit: Bathing

(_)Actual (_)
Potential

Related
To:
[Check
those that apply]
(_)
Neuromuscular impairment
(_) Visual disorders
(_) Trauma or surgical procedure

(_) External devices
(_) Aging process

(_)
Musculoskeletal disorders
(_) Immobility
(_) Nonfuntioning or missing limbs
(_) Other:_____________________________

____________________________________
____________________________________

 

As
evidenced by:
[Check
those that apply]
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:

(_)
Perform bathing activity at expected optimal level.

(_) Demonstrate use of
adaptive devices for bathing.

(_) Other:

  (_)
Assess for causative factors.

(_) Provide opportunities to relearn or
adapt to activity.

(_) Teach patient to
use affected extremity to accomplish tasks.

(_) Consistent bathing
routing at ___ am/pm every day.

(_) Provide as much
privacy as possible by pulling curtains and closing
doors.

(_) Provide equipment
within easy reach.

(_) Encourage
independence.

(_) Reinforce success
for task accomplished.

(_) OT consult for:

  • Adaptive devices
  • Safety measures
    for home
  • Other:

 

(_)
Other:________________
________________________

________________________
________________________

 

 

__________________________
Patient/Significant other signature

 

__________________________
RN signature