NURSING EXPECTED PATIENT ASSESSMENT ACTION TEACHING

DIAGNOSES OUTCOMES interventions: interventions: interventions:

(consider orders, (consider home
(note priority for Be sure they are S. (assess / monitor
safety, allergies, regimens,
each below) M. A. R. T. (Specific, for )
code status, fall procedures,
measureable,
(Be sure to use risk, etc.) discharge plan,
achievable/
related to and etc.)
attainable, relevant
as evidenced
and time-bound)
by)

Risk for fall r/t 1. Patient will 1. Assess the 1. Evaluate the 1. Assess the
hip fracture and remain free of falls patient for patients patients home
left hip during their time balance and medications to and external
arthroplasty here at VMRC mobility skills. determine environment for
whether threats to safety.
2. Living 2. Monitor the
medications
environment will be patient for 2. Instruct the
increase the risk
changed to best physical activity patients
of falling.
minimize the that is within family/caregiver
incidence of falls. their ability. 2. Recognize that on how to correct
when people identified
attend to hazards.
another task
while walking,
they are more
likely to fall.

Impaired 1. Ambulation with 1. Assess 1. Screen for 1. Teach the

physical mobility just FFW by the end patients additional patients family/
r/t surgical of the month. mobility measures of caregiver to work
procedure AEB progress at the physical function with the patient
2. Perform
use of assistive end of every to assess during self-care
resistance exercises
devices shift. strength of activities using a
that involve all major
muscle groups. restorative care
muscle groups 2. Monitor and
philosophy to
(especially left leg) record the 2. Consult with
restore them to
performed 2 or 3 patients ability physical
maximum
days per week to tolerate therapist for
function and
activity and use further
independency.
all 4 extremities. evaluation,
strength 2. Teach the

1
 training, gait patient relaxation
training, and techniques such
development of as deep
a mobility plan. breathing and
stretching to use
during activity.