[Care alerts (icin) Faceplate ‘Name: Address: Contact no: Doctor: Medicare no: Date of birth: Doctor's contact no: Pension no: Care plan Diabetic Communication — Preferred name: Agnes “Language’s spoken ERIE Care needs: Goal: (expected outcome) Vision Hearing “| ‘Aids RR magnifying glasses | Aids Clean and fit glasses daily Adjust volume daily __ | (Check batteries and clean aids daily Place objects in range of vision Gain attention before speaking Read aloud - Speak loudly, clearly and directly letters/documents Allow extra time for response Assist to write Give step-by-step instructions Assist to use telephone Use repetition when difficulty persists Other Other Eye care required Ear care required ‘Speech and language ‘Comprehension issues (For example: inappropriate ther | Speech disorder/s ‘Translate for client ‘Take time to listen Initiate conversation ‘Use language cards | Use picture cards. responses) Mobility” a Care needs: | Goal: (expected outcome) [LAmbulation (walking) Transfers eBiay a tad ia non-ambulant (unable to walk) | non-weight bearing (unable to stand) I-staffassist 2-staffassist hip replacement RBSEESGEHIEn | amputee (left al) | ‘Aids walking stick ARRIBA | Aids bedrail —_stidesheet gait belt Wheelchair quad stick hoist standing hoist wheeled walker Hoist sting pe and positon of oop ‘Other Otter Provide direction | Supervise movement | _] icra) l Care plan Pagel of 5Care plan Date of birth: Address: Contact no: Doctor: Doctor's contact no: Medicare no: Pension no: Failedng and contin Goal: (expected outcome) To Continence: Care needs: Potential for skin breakdown due to incontinence maintain good skin integrit [adder control Bladder management continent ERAGE cathe si, RBH ot notes) [Bowel controt Bowel management continent HSRSHIE constipation colostomy (IAG sexy wat ineoninece)_| [high bre diet encourage uid intake sperints —_ ESHA Continence aids Pay Rice Night Tolleting Toileting aids GERACE urinal ‘widome Tye ‘bed pan over-oilet frame __ Other Toileting regime independent Adjust clothing Other ‘Showering, dressing sand grooming Care needs: Potential for infections related to incontinence Goal: (expected outcome) To maintain optimal personal hygiene ‘Shower and washing independent supervise SSHEGARUNCOPIONEY fully asi moval bath bed sponge flannel wash Frequency Preferred time Adjust water temperature ARATE Other ‘Transfer | Naa wheelchair Other Showering aide ae Oar 7 Toiletries normal soap deodorant. fglGalGHla) moisturiser (am pm) other Hair care SR RESOEL ‘wash in bath refered days Grooming Hair care independent supervise some assistancefprompt alia Hairdresser Facil ini wetshave == dryshave——requeny i Hate removal Fre quene _ Nailfoot care independent some assistancelprompt fully assist Podiatry visits | Teeth none some (upper lower) @ ‘leaning routine Dentures BOE partial fall (upper lower) ‘int in out leaningroutne Care plan Page 20f56 ‘Name: Date of birth: i Address: : Contact no: Doctor: Doctor's contact no: Medicare no: Pension no: Care plan Dressing and undressing calipers splints Other (Cultural dressing: ‘Dressing assistance Pre Care need: Goal: (expected outcome) Norton Seale ‘Score [1 tow risk (medium risk (high risk Pressurerelief aids bedradle sheepskin cushion bedrail/protectors Other Pressure area regime Reposition in bed Reposition in chair ‘Frequency special matress (type ) personal chair theres orders emollient cream to dey skin areas (GH vice daily) Preereu ner ihing se Se eae aa Goal: (expected outcome) Eating supervise some assistance/prompt fully assist left-handed Preferred place to eat ‘bedroom nc ‘| ‘Type of di sof ‘modified soft (minced) puree Special diet diabetic enteral feeding (PEGINGT) Special instructions ‘Aids modified crockery modifiedcutlery bowl __lipped plate built up cutlery clothing protector ter [Drinking a PGGRERGER —supervise some assistance/prompt fully assist HIGRERHEAE left-handed ‘Aids modified cup clothing protector Thickened fuids Tevell level level 3 ‘Type of thickeuer tobe used a aaa a a Ae S i ae See Benes Care needs: Goal: (expected outcome) —_ aa ‘Usual time to rise Usual time to bed HB Rest time (am Bil) Preferred letping poston Pillows required Sleep Aids massage music HGR _orner Room light on door open SQGERIBME —_bedrail/protectors _ other [Night-time patterns her preferences (For fees or socks) [Night checks every hour every 2 hours ‘Other Care plan Page 3 of SCare plan ‘Name: Date of birth: Address: Contact no: Doctor: Doctor's contact no: Medicare no: Pension no: TERRE supervise some assistance/prompt fully assist ERG measure selfadminister Blood sugar level testing | independent supervise ‘some assistance/prompt fully assist Pastoral segeirrents ‘Community care social outings Requirements ‘Taxi vouchers Religion beliefspractices FIER ‘Coltural needs Hobbiesiinterests [f ‘Employment history REESE) Pets Typels RE ARGRRENPE © —_requires prompt and assistance in pet care fully assist pet care Social group/s Brags Preferred activityigames BRGEd Frequency (daily — every 2 day weekly ABERIRHBRY omer ) sii Washing clothes nit Cooking a snes nin ns TTR a Other Care plan Page 4 of SDoctor's contact no: Pension no: Behaviour | Care needs: Goal: (expected outcome) | Terminal care recorded [Y No. Additional comments (For example: special needs, resin, routines, pin, palliative cae, pacemake) ‘Date care plan evaluated (document in progress notes) Signature Page 5 of S