Aide Care Plan - Kinnser

1 Kinnser Software 2016. aide care plan Page 1 of 2 aide care plan Clinician: Patient Name (Last Name, First Name) & MRN: Mileage: Gender: Agency Name/Branch: M F Date: / / Time In: Time Out: DOB: / / Functional Limitations Amputation Paralysis Legally Blind Hearing Bowel/Bladder Incontinence Endurance Dyspnea Contracture Ambulation Speech Other: DME Bedside Commode Cane Hospital Bed Grab Bars Elevated Toilet Seat Nebulizer Oxygen Wheelchair Walker Tub/Shower Bench Supplies ABDs Ace Wrap Alcohol Pads Chux/Underpads Diabetic Supplies Drainage Bag Dressing Supplies Duoderm Exam Gloves Foley Catheter Gauze Pads Insertion Kit Irrigation Set Irrigation Solution Kerlix Rolls Leg bag Needles NG Tube Probe Covers Sharps Container Sterile Gloves Syringe Tape Other.

2 Activities Permitted Complete Bed Rest Up as Tolerated Exercise Prescribed Cane Independent at Home Bed Rest with BRP Transfer Bed-Chair Wheelchair Crutches Partial Weight-Bearing Walker Other: Vital Sign Notification BP Systolic > < Pulse > < Respiration > < BP Diastolic > < Temperature > < No Bowel Movement in 3 Days Foley: Weight Gain or Loss: aide care plan Patient Name (Last Name, First Name) & MRN: Date: / / Kinnser Software 2016.

3 aide care plan Page 2 of 2 Vital Signs Frequency Household Frequency Blood Pressure Change Linen Pulse Light Housekeeping Respiration Make Bed Temperature Personal care Weight Assist of Dress Elimination Back Rub/Massage Assist w/ Bed Pan Check Pressure Areas Assist w/ Bedside Commode Comb Hair Catheter care Complete Bath Empty Ostomy Bag Foot care Incontinent care Nail care Record Bowel Movement Oral Hygiene Denture care Activity Partial Bath/Sponge Assist in Ambulation Pericare Assist in Transfer Shampoo Hair Range of Motion Shave Turn or Position Skin care Tub/Shower Universal Precautions Additional Comments