SUBJECTIVE OBJECTIVE

SKIN INTEGRITY: [ ]Dry [ ]Cold [ x ] Pale

[ ] Dry Comments: [ ]Flushed [ ] Warm
[ ]Itching Uniform colour and has no [ ] Moist [ ] Cyanotic
[ ]Others blemishes. Her skin appears *Rashes, ulcers, decubitus (Describe size,
[ ] Denied clammy and somewhat pale. location, drainage)_____________________________
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ACTIVITY/SAFETY: LOC and Orientation ___________________
[ ]Convulsion Comments: _____________________________________
[ ] Gait [ ] Walker [ ] Care [ ] Other
[ ]Dizziness She has been more [ ] Steady [ ] Unsteady
fatigue lately. But Sensory and motor losses in face or extremities
[ ]Limited motion she can walk _____________________________________
Of joints independently. _____________________________________
Limitation of ability to [ ] ROM limitations _____________________
[ x ] Ambulate _________________________ _____________________________________
[ x] Bathe itself _________________________ _____________________________________
[ ] Other _________________________
[ ] Denied _________________________
COMFORT/SLEEP/AWAKE
[ ] Pain Comments: [x ] Facial grimaces
(Location, frequency [ x ] Guarding
Remedies) Difficulty of sleep [ ] Other signs of pain ___________________
[ ] Nocturia due to persistent ______________________________________
[ x ] Sleep difficulties cough experienced. [ ] Side rail release form signed (60+ years)
[ ] Denied ______________________________________
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COPING:
Occupation : teacher Observed non-verbal behaviour : none
Members of the household: husband and ______________________________________
daughter. Person (Phone Number) : 09972626655
Most Supportive Person : husband ______________________________________