ASSESSMENT GUIDES ADULT HEALTH ASSESSMENT HEALTH HISTORY Identifying information Name, residence, telephone, age or date of birth

, sex, race, ethnicity, religion, marital status/significant person/contact person, language, education, occupation, financial/insurance, source of information, advance directive Past history • Statement about general health • Other medical conditions and dates of onset or occurrence; health status in past year • Surgeries and injuries and dates, known or suspected allergies (food, drug, environmental allergens) • Hospitalizations for injuries, surgery, or medical problems (condition, date, duration) • Admittance to long-term care facility (reason, date, duration) • Immunizations and dates • Military history, travel and dates • Childhood diseases and ages of occurrence • Psychiatric illness and treatment • Usual health care pattern and kind of practitioner used • Use of rehabilitative and support personnel, past home care services • Life-style patterns and personal habits in sleep, nutrition, fluid intake, urinary and bowel elimination, activity, sexual pattern, personal hygiene, others Present history • Chief complaint or health concern (in client’s words, if possible) • Onset and development of problem, where it took place, what was done • Signs and symptoms, location, severity, duration, frequency, changes and effect on client, meaning of illness to client • Factors that alleviate or aggravate symptoms • Client’s knowledge of disease, procedures, and planned therapy • Client’s adaptation to chronic disorder • Laboratory and diagnostic test and procedures performed and results • Medications and treatments ordered since discharge • Homebound status Family history • Spouse, children, parents, siblings, including health status, ages, occupations, deaths and causes; pets in the home

• Roles and responsibilities of family members, relationship with family members, activities, response to stress or crisis • Support systems within family, marital relationship • History of abuse by family members or relatives • Adaptation of family members to care of client in the home Psychosocial history • General appearance • Health goals and practices • Alcohol, caffeine, and tobacco consumption: type, amount, frequency • Living arrangement (alone or with others and relations with them) • Occupation and income, ability to pay for health care, insurance plan (Medicare, Medicaid, CHAMPUS, private insurance, workers’ compensation) • Education, degree, profession if applicable • Recreation and interest, social and other activities, hobbies, travel, retirement if applicable • Friends, community involvement, clubs, organizations, or church activities Mosby items and derived items © 2009 by Mosby, Inc. Page 1 • Use of community agencies (Meals on Wheels, hospital or clinic, day care, transportation, home cleaning services, shopping services) • English as a second language or no English spoken • Review of a usual day’s activities • Emergency contact and telephone number Medications and treatments • Prescribed and over-the-counter drugs: name, type, dose, frequency, route, length of use, side effects, desired effect, conditions being treated, drug from and how administered, contraindications, and risk for toxicity • Oxygen and other inhalation medications or treatments • General compliance with medication regimen • Street or recreational drug use • Aids to ensure safe, correct self-administration of medications • Effect of client’s age on absorption and excretion • Treatment for adverse effects Review of systems • Height, weight, vital signs, and temperature Pulmonary system • Upper or lower respiratory disease or infections (acute or chronic) • Dyspnea (at rest or exertional), pain in sinus, nose, throat, or chest; congestion or discharge from nose (rhinorrhea, epistaxis, snoring); hemoptysis; cough (productive or

nonproductive, with sputum characteristics); hoarseness; olfactory perception; wheezing; abnormal breath sounds Cardiovascular system • Heart disease (chronic, acute, congenital), vascular disease( hypertension, arterial or venous circulatory disorders) • Chest, arm, throat, jaw pain; leg pain or claudication; paresthesias edema; varicosities or ulcer; dyspnea (exertion, nocturnal); palpitations; orthopnea; murmur; abnormal heart sounds Neurologic system • Neuromuscular or neurosensory conditions; head or spinal trauma; seizure activity; vertigo or syncope; headache; tremors or spasms; paralysis; paresis; paresthesias; mentation charges (memory, orientation, level of consciousness); motor changes (gait, coordination); sensory perception changes (touch, taste, smell, vision, hearing); presbycusis; presbyopia; tinnitus; eye or ear pain or drainage; pruritus; photophobia; blurring; diplopia; floaters; use of glasses, contact lenses, hearing aid; sleep and rest pattern (rested, fatigue, muscle cramps); speech pattern (aphasia, slurred, alternate speech method) Gastrointestinal system • Gastrointestinal, hepatic, biliary disorders; abdominal pain; nausea; vomiting; diarrhea; constipation; indigestion; heartburn; rectal bleeding; hematemesis; flatus; belching or eructation; jaundice; dysphagia (swallowing difficulty); chewing difficulty; anorexia; changes in appetite; presence and fit of dentures; caries; oral pain, bleeding, or lesions; halitosis; changes in gustatory perception; recent weight loss or gain; food intolerances, dislikes, and habits; special diet; 24-hour dietary intake review; bowel pattern review Endocrine system Mosby items and derived items © 2009 by Mosby, Inc. Page 2 • Glandular dysfunction (thyroid, pancreas, adrenal, pituitary), polyuria, polydipsia, changes in metabolic function, skin color and texture, hair, tolerance to heat and cold, Cushing’s response to corticosteroid therapy Hematologic system • Anemia, type and cause; weakness; pallor; night sweats; lymph node enlargement; skin hemorrhages; bruising; petechiae; bleeding from any site; previous transfusions#(blood or blood products) Musculoskeletal system • Bone or joint disease; fracture; pain or stiffness in joint and muscles; redness, swelling, or heat at joint sites; deformity; limited range of motion (ROM) and movement; fatigue; weakness; energy and endurance; ability to perform activities of daily living (ADL) (total, assisted), deficits and use of assistive devices; limb prosthesis; exercise or activity pattern review; rehabilitation services; reaction to disability; Katz index of ADL independence Renal/urinary system • Upper or lower renal tract disorders, urinary pattern review, difficulty in urination (dysuria, dribbling, urgency, frequency, oliguria, nocturia, retention, incontinence),

hematuria, calculi, dialysis, urinary tract infection, presence of catheter, 24-hour fluid intake and output, dialysis Integumentary system • Skin color; eruptions; elasticity; turgor; texture; scarring; dryness or moisture; pruritus; alopecia; hair and nails characteristics and changes; corns; calluses; infection; pattern of daily skin, hair, nail care review Reproductive system • Breast and male or female genital or organ disorders, sexually transmitted diseases, infection, lesions, discharges, bleeding, pain (testicular, pelvic, dyspareunia), infertility, impotence, pattern of sexual activity and changes, menstrual information (menarche, last period, abnormal bleeding or irregularities, menopause), pregnancies (live births, abortions, complications), penile implant Psychosocial/psychiatric/mental • General appearance, depression, sadness, chronic anxiety or worry, dementia, delirium, mood swings, stressors, self-concept and self- esteem, delusions, combativeness, cognitive impairment (memory, attention span, orientation, judgment), intellectual function , disengagement or reclusiveness, thoughts of suicide; Mini-Mental State Exam, Short Portable Mental Status Questionnaire, Beck Depression Inventory, Yesavage Geriatric Depression Scale, OARS Social Resource Scale, Family APGAR Mosby items and derived items © 2009 by Mosby, Inc. Page 3 PEDIATRIC ASSESSMENT HEALTH HISTORY Information in the health history is inclusive. It may be elicited from the caregiver or other family members or may be obtained from medical records. Modification may be necessary to adapt to client and family needs and abilities. Identifying information Date of interview, informant/complainant, source of referral Name (of child), including nickname First names of parents and last names, if different; their ages, occupations, educational levels Others in household; their names, ages, relationships with client Address Home and work telephone numbers Age, date of birth Sex, race, religion, nationality, place of birth Language ability (age appropriate), preference, need for translator Community agencies used, telephone numbers Support systems, telephone numbers Current illness 1. Chief complaint or reason for visit (in client’s or caregiver’s words) 2. Profile of illness, using PQRST mnemonic: P—prodromal, precipitating factors Q— qualitative, quantitative factors R—region, radiation S—severity (on a scale of 1 to 10)

T—timings (date, onset, manner) 3. Progression of illness and effect of therapy From Melson KA, Jaffe MS: Pediatric and postpartum home health nursing: assessment and care planning, St Louis, 1997, Mosby. HISTORY 1. Perinatal history a. Health of mother before, during pregnancy Maternal age, length of pregnancy, gravida and parity, extent of prenatal care 2. Illnesses, medical conditions, exposure to communicable disease, complications relating to pregnancy, blood type Medications used and prescribed, exposure to toxins or chemicals Responses to pregnancy b. Duration, nature, severity of labor; use of sedatives, analgesics Type, date, location of delivery Procedures performed Complications c. Infant status, health at birth; Apgar score Weight, length, estimated gestational age Developmental history Age, height, weight, dentition Performance of age-related developmental tasks, observed and recounted periods of delayed or accelerated growth, comparison with siblings, parental perceptions Grade expected and attained, quality of schoolwork Extracurricular activities, play Family/social relationship Activity/performance history General disposition, personality, temperament Rituals, behaviors, responses to discipline or frustration Play and diversional activities, amount and type of exercise Eating patterns, food intake, alternative feeding management Sleep/nap patterns, duration, disturbances, aggravating and alleviating factors Urinary/bowel control, patterns, problems, remedies Sexual maturity, activity, concerns Drug use/abuse Childhood diseases Type, age, severity, complications, sequelae Immunizations Type, date, dosage, boosters, unusual reactions Presence of written record Medications Mosby items and derived items © 2009 by Mosby, Inc. Page 4 3. 4. 5. 6.

Over-the-counter, prescribed, borrowed; home remedies Type, condition being treated, dose, frequency, duration, form, side effects; medication label directions, pill count, as appropriate Safe, accurate administration by observation, childproofing measures 7. Allergies Hypersensitivity to foods, drugs, animals, insects, plants Hay fever, asthma, allergic rhinitis, eczema, urticaria 8. Serious illness Illness, injury, accidents: date, symptoms, family prevalence, course, pattern, recurrence, complications, sequela Dates and description of hospitalizations, surgeries Dates and results of special producers, testes, screening panels Presence of indwelling, central venous or peripheral catheters, tracheotomy; competence with use, maintenance 9. Family medical history Age, sex, health status of family members Genogram child’s biologic maternal/paternal grandparents, parents, offspring, aunts, uncles, first cousins; indicate age, health status/problems, cause of death; include stillbirths, miscarriages, abortions Familial illnesses, conditions, anomalies (e.g., cardiovascular disease hypertension, cerebrovascular accidents, cancer, diabetes, any condition correctly suspected of diagnosed in client) life-style choice (e.g., substance use/abuse, sedentary behaviors) 10. Psychosocial history Family structure, roles and functions, cohesiveness Family expectations, attitudes, outlook, bonding behaviors Language spoken at home, communication patterns Marital status, relationships, significant others Educational levels, current and past employment, socioeconomic status, caregiver work schedules Home environment adequacy, safety Ethnic, cultural, religious milieu Lifestyle, health care beliefs; recreation, perceived stressors, health care concerns Relationship with peers, employer, coworker, schoolmates, community Support systems, coping capacity of caregiver, resources REVIEW OF SYSTEMS General General state of health, ability to perform age- dependent activities of daily living, unexplained weight change, fever, fatigue, constitutional symptoms, serious illness Pulmonary system Shortness of health (at rest, on exertion, positional), wheezing, stridor, frequent colds, infections, cough, hemoptysis, sputum production, date and results of last tuberculin skin testing and chest x-ray examination use of ventilatory aids/devices

Cardiovascular system History of familial cardiac anomalies, congenital defects, heart murmurs, anemia, unexplained or disproportionate fatigue, activity intolerance, failure to gain weight, delayed growth/development, marked pallor, cyanosis, orthopnea or preference for squatting position, tachypnea, tachycardia, edema, dates and result of latest hematologic examination, electrocardiogram, echocardiogram Neurologic system Maternal drug use, birth injury or anomaly, prematurity, trauma, delayed development, use of ototoxic drugs, tremors, spasms, seizures, ataxia, paresis, paresthesias, paralysis, any abnormal involuntary movement, difficulties with balance or coordination, difficulty swallowing, sensory Mosby items and derived items © 2009 by Mosby, Inc. Page 5 defects or disturbances, delayed language development/speech problems, learning difficulties, altered level or loss of consciousness, memory loss, change in cognitive ability, behavior, affect Gastrointestinal system Appetite, dietary intake, food intolerances, difficulty swallowing, weight change, anorexia, nausea, regurgitation, vomiting, pain, bowel control/habits, excessive eructation or flatulence, diarrhea, constipation, change in color/appearance of stool, infection, rectal pain/bleeding Endocrine system Changes in weight, skin texture, hair distribution, pigmentation; weakness; fatigue; temperature intolerance; delayed/accelerated growth and development; polydipsia; polyphagia; polyuria; delayed/accelerated sexual maturation; personality changes; headache; visual disturbances Hematologic system Local to generalized bleeding from any site (spontaneous or disproportionate to injury); petechia; epistaxis; bruises; hyperbilirubinemia; anemias; fatigue; activity intolerance; weakness; pallor; exposure to/ingestion of chemicals, drugs, toxins; recent and past infactions; chronic disease; transfusion history Musculoskeletal system Strength, coordination, gait, ability to perform age-dependent activities of daily living, spinal curvature, back pain, movement limitations, fractures, deformities; muscles weakness, cramping, pain; joint stiffness, erythema, edema, pain; assertive/prosthetic devices Renal/urinary system Renal and nonrenal congenital anomalies, past infections, fever, trauma exposure to nephrotoxic drugs or heavy metals, bladder control/habits, number of wet diapers, changes in color/odor of urine, force of stream, oliguria, dysuria, hematuria, frequency, urgency, hesitancy, nocturia, enuresis, back or flank pain, anemia Reproductive system Sexual maturity and activity; genital discharge; pruritus; lesion; rashes; breast pain, masses, discharge; measures to prevent pregnancy, sexually transmitted diseases

• Female; menarche, last menstrual period, menstrual pattern, and results of last Papanicolaou smear, performance of breast self-examination • Male: descended testicles, circumcision, scrotal swelling, lesions, masses, performance of testicular self-examination Integumentary system Pruritus; jaundice; rashes; moles; birthmarks; congenital anomalies; scaring; petechia; lesions; acne; ecchymoses; excessive oiliness or dryness; changes in amount/texture of hair; changes in appearance, configuration/color of nails; lice infestation; insect bites; exposure to drugs; plants, environmental toxins; recent travel Eye, ear, nose, and throat • Eye: infection, discharge, excessive tearing, itching, photosensitivity, pain, edema of lids, yellowing of sclera, blurred or double vision, changes in vision, strabismus, use of corrective lenses, date and results of last eye examination • Ear: infection, discharge, earache, tinnitus, change in hearing, vertigo, delayed speech development, date and results of latest auditory examination • Nose: obstruction, stuffiness, discharge, sneezing, allergies, sinus pain, epistaxis, altered sense of smell • Throat: difficulty chewing/swallowing, tongue soreness, sore throat, change in color/integrity of mucosa, hoarseness, voice aberrations, dentition, toothache, caries, gum swelling/bleeding, abscesses, pattern of dental hygiene, data results of last dental examination Mosby items and derived items © 2009 by Mosby, Inc. Page 6 Psychologic Facial expressiveness; body posture; grooming, personal hygiene; speech, language usage; mood; affect; tension; memory; cognitive function; performance of developmental tasks; activity patterns; coping abilities; relationship with family, peers, schoolmates, authority figures; school performance Mosby items and derived items © 2009 by Mosby, Inc. Page 7 GERIATRIC FUNCTIONAL AND HEALTH ASSESSMENT PURPOSE OF REFERRAL What is the immediate problem for which the patient, family, or others need help? What event(s) led patient to seek help specifically at this time? HEALTH ASSESSMENT 1. Is patient under any unusual stress such as financial, home situation, transportation, family or personal relationship? 2. Which of the following best describes how patient feels? This is the best time of life While some things are more difficult now, life is usually pleasant and acceptable. Just as happy now as when patient was younger Life has become unpleasant and difficult to tolerate Very unhappy with present situation 3. Which of the following best described patient’s state of health?

Usually good Average health Below average Very poor 4. Does patient have (or has patient had) any of the following symptoms? If yes, for how long? Frequently headaches Passing out or fainting Falling or stumbling Paralysis or log or arm weakness Numbness or loss of feeling Tremor shaking Forgetfulness Problem with memory Disorientation to time, person, or place Depreciation Agitation Hallucinations (hearing voice and/or seeing things) Suspiciousness of other Fearfulness Unusually high or low moods Difficulty sleeping Difficulty speaking Difficulty understanding what others say Difficulty swallowing Hoarseness or other change in voice Visual or eye problems (data of last visit to eye doctor) Hearing or ear trouble (data of hearing examination) Dental problems, dental discomfort (data of last visit to dentist) Fever or sweats Swollen gland Difficulty breathing Persistent cough Chest pain or tightness Irregular heartbeat Leg pain when walking High blood pressure Poor appetite Change in weight Frequent indigestion or stomach ache Frequent nausea or vomiting Change in bowel habits Black bowel movements or rectal bleeding Frequent diarrhea Constipation Urination at night Painful urination Difficulty starting or stopping urination Difficulty holding urine or urine leakage Sexual difficulties Back or neck troubles Joint pain or stiffness Swelling of feet or ankles Foot problems Women only: Breast lumps or discharge Vaginal bleeding/discomfort Men only:

Discharge from penis Swelling/lump in testicle Ache in lower back or groin Mosby items and derived items © 2009 by Mosby, Inc. Page 8 5. Other problems Sleeping problems Feeling lonely Change in sexual interest Feeling sad or depressed Change in sexual activity Thought of “ending it all” Feeling tense or anxious Change in appetite 6. Past medial history (approximate dates) Alcoholism Anemia Arthritis Asthma Bronchitis Cancer Cataracts Depression Diabetes Emotional problems Fractures Gallbladder problems Glaucoma Heart disease Hernia High blood pressure Jaundice Kidney disease Liver disease Lung disease Mental illness Nervous breakdown Prostate disease Phlebitis Pneumonia Seizures Stomach ulcers Stoke Thyroid disease Tuberculosis Urinary tract infection Other 7. Hospitalization (location, dates, reason) 8. Family health problems (for each, relationship to patient; if the patient has died, give age at time of death and cause of death) 9. 10. 11. 12. 13. 14. Alcoholism Cancer Depression Heart disease High blood pressure Kidney disease Memory problem Mental illness

Nerves breakdown Speech or language disorder Stroke Other Smoking Does patient now, or did patient ever, smoke citrates/cigar/pipe, or chew tobacco? How much? For how long? When did patient stop? Does patient drink alcohol? If no, why not? If yes, how much? How often? (less than 3 times a week , more than 3 times a week, daily) Is alcohol a problem? Prescription medication (names, dosages, how often, how long taken) Medication taken in addition to prescription drugs (aspirin antacids, cold pills, vitamins/minerals, other) Medication allergies Are doing any of the following activities a problem for the patient? If yes, who helps? Shopping for groceries Preparing own meal Eating Doing housecleaning Writing checks or paying bills Taking sponge or tub bath, or shower Dressing Using the telephone Walling indoors Walling or down stairs Going up or down stairs Getting into or out of bed or chair Getting off or on toilet Mosby items and derived items © 2009 by Mosby, Inc. Page 9 15. Does patient use any prosthetic devises or aids (glasses, hearing aids, cane, wheelchair, contract lenses, dentures, walker, other)? 16. Where does the patient live (apartment [nonpublic], home [owned], foster home, public housing, subsidized housing, nursing home, other)? 17. With whom does patient live (alone, children, companion or friend, spouse or partner, another relative, other)? 18. With whom is patient in regular contract (spouse or partner, child or children, brothers[s], or sister[s], friend[s], neighbor[s])? 19. Who does patient call on for help? 20. How often in the past week has patient left home (e.g., going to church, meetings, or other activities)? 21. What interests and activities does patient

most enjoy? 22. Which best describes patient’s employed status? Never fully employed (outside the home) Retired—when? Presently working (full-time, part-time) 23. Patient’s present or past occupations 24. Which of the following best described patient’s financial status? Conformability able to afford necessities (food, clothing, and transportation) Able to afford necessities with careful budgeting Barely able to afford the basic needs Unable to afford the necessities 25. What is patient’s usual from of transportation? Drives own car Rides with a friend or relative Takes a cab Doesn’t go out of house or apartment 26. Which of the following services has patient used in the past 3 months? Who provides the services? Personal care Nursing services Medical care (physician) Mental health services Social services Physical therapy Hearing or speech testing or therapy Sight cancer Rehabilitation services Nutritionist Transportation Day center Meal program Other 27. How many meals a day does patient eat? 28. How many snacks a day does patient eat? 29. How many cups of fluids per day does patient drink (including tea, coffee, water, juice, milk, soda pop, etc,)? 30. Concern about diet or nutrition? MENTAL STATUS 1. Does patient sleep well? 2. Does patient feel well rested? 3. Ease of falling asleep 4. Nap pattern 5. Hours per night/times up during the night 6. Concerns of patient/family SENSES 1. Sight 2. Hearing 3. Taste 4. Smell 5. Touch ACTIVITIES OF DAILY LIVING (for each, is patient independent or dependent?) 1. Bathing Initiation of bath Type of bathing (tub, shower, sponge) Bath preparation

Get in/out of tub Ability to wash self Hair washing 2. Dressing Clothing selection Putting on garments Mosby items and derived items © 2009 by Mosby, Inc. Page 10 6. Does patient wet when coughing or sneezing or at other times? 7. Where is center of concern about wetting (patient, family, both)? 3. Transfer From bed to chair From chair to standing MOBILITY Doing up bottom, etc Appropriateness of attire Undressing Laundry 4. Toileting Able to find bathroom Able to use toilet appropriately Hygiene 5. Bowel continence Frequently Constipation 6. Feeding 1. Walking ability (use of assistive devise) 2. Distance able to walk (and frequently) 3. Gait, positive 4. Stuffiness (morning, after inactivity, evening, where)? 5. What does patient do to maximize mobility 6. Hand dexterity and function 7. Problems with feet and shoes 8. Other concern of patient/family 7. Telephone Look up number Dial NUTRITION 1. Number of meals per day 2. Number of glasses of fluid 3. Indication, nausea/vomiting, change in bowels 4. Dentition 5. Appetite 6. Weight stability 7. Concerns of family (need for referral to nutrition) 12. Food preparation SAFETY 8. Medication Preparation Taking 9. Outside of home Organization Getting lost 10. Driving

11. Housework Organization Doing (List what able to do) Planning Shopping Preparing 13. Finances Banking Paying bills Balancing checkbook URINARY CONTINENCE 1. Does patient have “accident”? (If “yes” when?) 2. Patient’s knowledge of accidents 3. Frequently 4. Urgently 5. Can patient get to bathroom in time? 1. Is patient alone at any time? 2. Does patient get lost 3. Kitchen safety 4. Household safety (rugs, cords, railings, stairs) 5. Other concerns CARE GIVER 1. Name of formal care giver, relationship 2. Informal care-giving system 3. Care giver’s role/function 4. Impact of care giver/family 5. Assessment of stability/security provide in present care environment Mosby items and derived items © 2009 by Mosby, Inc. Page 11 8. Other concerns FAMILY ASSESSMENT PHYSICAL HISTORY • Chronic illness of family members • Functional abilities or disabilities • Energy levels of family members and how physical needs of its members are met • Physical strength and ability top perform procedure • Rigidity in functioning within family system • Health practices • Type of practitioners used • Medication taken by family members PSYCHOLOGICAL HISTORY Emotional status/mental status • Change in family life and roles caused by client needs • Family unable to meet emotional needs of its members

• Ability to family members to express • Family patterns in use of coping mechanisms (denial; rationalization, projections, defensiveness) and ability to adapt • Family organization (arguments, separations, divorces) • Willingness to performs procedure and care for client • Support to client by member most likely to become caregiver • Family APGAR for family PSYCHIATRIC DISORDERS • General mental health of family • Psychosomatic tendency • Chronic anxiety in family members • Depression in family members • Presence of alcoholism, family violence, sides, drug abuse CULTURAL INFLUENCES feelings • • Ability of family to accomplish General values and ethnic identify to family Spiritual beliefs, religious affiliation Language barriers, English as a second language Beliefs regarding health care and health professionals development task • Ability to communicate clear massage, solve problems, and make decisions • Family attitude, overconcern toward illness or disability, relationship of client and family members •• • Mosby items and derived items © 2009 by Mosby, Inc. Page 12 ENVIRONMENTAL ASSESSMENT HOME EXTERIOR • Primary entrance • Steps or ramp available if needed • Homebound or able to leave home safely HOME INTERIOR • Condition and cleanliness, noise, waste disposal • Space storage for extra equipment and supplies • Counter space for preparation of supplies, cleaning of equipment • Refrigeration for foods, medications, supplies • Location of fuse or circuit breaker box • Proper lighting, frayed or loose wiring or electrical connections, grounding of equipment • Heating and air conditioning adequacy • Wood stove or kerosene heater use and ability to fuel fire

• V entilation, temperature control, drafts • Laundry facilities for clothing, linens, supplies • Doorways and if adequate to move through easily, to accommodate wheelchair, commode, and to allow for delivery of equipment • Floors and pathways clear, dry, and not slippery; arrangement of furniture out of pathways but close enough to use for support when ambulating; small rugs and carpet edges out of pathways • Stairway, number of stairs and height of stairs: room on first floor or need for client to be transported upstairs • Safety bars and holding aids for movement within environment From Jaffe MS, Skidmore-Roth L: Home health nursing: assessment and care planning, ed 3, St Louis, 1997, Mosby. • Hot and cold running water or means to heat water, indoor plumbing versus drawn water • Bathroom, commode within easy access • Presence of allergens, dust, animals, plants, sprays, odors SAFETY FACTORS • Client’s feeling of safety in home • Hospital bed, trapeze connection • Side rails up or bed in low position if using hospital bed • Call bell, water, tissues, wastebasket, telephone within reach • Chair to assist to standing position • Scales for weight in bathroom or near bed • Proper body alignment and positioning if on bed rest • Use of restraints, smoking and precautions taken • Isolation or protective isolation procedures needed • Nonslip mats in bath or shower • Night-lights if out of bed at night to use bathroom or commode • Safety aids for ADL to prevent falls, promote self-care; amount of assistance needed, proper fitting nonskid foot covering • Proper hand-washing technique when required • Proper administration of medications and use of aids to ensure accuracy • Proper cleansing and disinfection of reusable supplies, removal and disposal of hazardous wastes • Available emergency numbers to call Mosby items and derived items © 2009 by Mosby, Inc.

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