Unit........................ | Ward....................... | Date........ | |||
Code caretaker................ | Assessment made by.................... | ||||
A. General Core | |||||
Items/point | 0 point | 1 point | 2 points | 3 points | 4 points |
Nutrition | |||||
Washing upper body | |||||
Washing lower body | |||||
Toilet visit | |||||
Dressing/undressing | |||||
Shower/bath | |||||
Mobilization | |||||
Observation/supervision/alarm | |||||
Social activities | |||||
Total | |||||
B. Medical care | |||||
Items/points | 0 point | 1 point | 2 points | 3 points | 4 points |
Wound treatment | |||||
Catheter/stoma | |||||
Administration | |||||
Injection | |||||
Rehabilitation | |||||
Total | |||||
C. Cognitive Care | |||||
Items/points | 0 point | 1 point | 2 points | 3 points | 4 points |
Orientation/sense of locality | |||||
Verbal communication | |||||
Confusion | |||||
Anxiety | |||||
Temper | |||||
Total |