Risk for Peripheral Neurovascular Dysfunction

 

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 at risk of experiencing a disruption in circulation, sensation, or motion of an extremity

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:

burns  fracture  immobilization  mechanical compression (cast, brace, dressing, restraint)  orthopedic surgery  trauma  vascular obstruction


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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