Self Care Deficit

 

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 unable to perform self care activities such as feeding, bathing, dressing, toileting

1. Your initials (required): 

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

None- high risk diagnosis  inabiltiy to bathe independently  inabilty to eat independently  inability to toilet independently  inability to dress independently

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

neuromuscular impairment  weakness  cognitive impairment  visual disorder  trauma  anxiety  pain 
treatment related (cast, IV, traction, braces)  medically imposed restrictions  lack of motivation, depression 
 


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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