Risk for Injury

 

Instructions: Fill out this form, print it, and hand it in with your assessment to your instructor. When you click on Next at the bottom of the page, you see the data you submitted. Please follow the instructions on how to save the data on the next page.

AOL users: Read this instruction.

Definition: a state in which an individual is a risk for harm because of a perceptual or physiologic deficit, a lack of awareness of hazards or maturational age

1. Your initials (required): 

2. Defining Characteristics- check those that apply to your client:

None- high risk diagnosis 

3. Related Factors- check those that apply to your client:

altered cerebral function  altered cognitive function altered neurological function, incoordination  altered mobility  impaired sensory function  pain  fatigue, weakness  medications  improper footwear  improper use of walking aid (cane, crutches, walker) environmental hazards (lighting, clutter, etc)  fire hazards  history of accidents, falls  unsafe storage of poisons or other dangerous materials 
other 


4. Goal (ultimate, long term) 

5. Outcome Criteria (short term) 

6. Evaluation: Was the outcome criteria met? 

Yes- Give Evidence:

No- Explain how you would change the plan: 

7A. Interventions 

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7B. Rationale for each intervention
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