Nurse's Pocket Guide

• Assess client/SO’s level of cognitive/emotional/physical functioning
to ascertain needs and capabilities in handling tasks
of home management.
• Identify lack of knowledge/misinformation.
• Discuss home environment/perform home visit, as appropriate,
to determine ability to care for self and to identify
potential health and safety hazards.
• Identify support systems available to client/SO(s) to determine
needs and initiate referrals (e.g., companionship, daily
care, household cleaning/homemaking, running errands).
• Determine financial resources to meet needs of individual
situation.
NURSING PRIORITY NO. 2.To help client/SO(s) create/maintain a
safe, growth-promoting environment:
• Coordinate planning with multidisciplinary team, as
appropriate.
• Assist client/SO(s) to develop plan for maintaining a clean,
healthful environment (e.g., sharing of household tasks/
repairs between family members, contract services, exterminators,
trash removal).
• Assist client/SO(s) to identify and acquire necessary equipment
(e.g., lifts, commode chair, safety grab bars, cleaning
supplies, structural adaptations) to meet individual needs.
• Identify resources available for appropriate assistance (e.g.,
visiting nurse, budget counseling, homemaker, Meals on
Wheels, physical/occupational therapy, social services).
NURSING PRIORITY NO. 3. To promote wellness (Teaching/
Discharge Considerations):
• Discuss environmental hazards that may negatively affect
health or ability to perform desired activities.
• Develop long-term plan for taking care of environmental
needs (e.g., assistive personnel to clean house/do laundry;
trash removal and pest control services).
• Identify ways to access/use community resources and support
systems (e.g., extended family, neighbors).
• Refer to NDs deficient Knowledge (specify); Self-Care Deficit
[specify]; ineffective Coping; compromised family Coping;
Caregiver Role Strain; risk for Injury.
Documentation Focus
ASSESSMENT/REASSESSMENT
• Assessment findings include individual/environmental factors,
presence and use of support systems.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
Diagnostic Studies Pediatric/Geriatric/Lifespan Medications 375
impaired HOME MAINTENANCE