Angelite Nurses: Disuse Syndrome

Disuse Syndrome

(_)Actual (_) Potential

**Related To:**
*[Check those that apply]*
(_) Unconciousness (_) Neuromuscular Impairment (_) Musculoskeletal condition (_) Immobility (_) Traction/casts/splints (_) Other:_____________________________ ____________________________________ ____________________________________

**As evidenced by:**
*[Check those that apply]*
Major: (Must be present)	(_) Presence of risk factors. (See above "Related To").

Date &
Sign.

Plan and Outcome
[Check those that apply]

Target
Date:

Nursing Interventions
[Check those that apply]

Date
Achieved:

The patient will:

(_) Maintain or regain free range of motion of extremities within limits of disease.

(_) Maintian or regain function of:___________
___________
within limits of disease.

(_) Other:

(_) Assess range of motion of affected extremities and the ability of patient to perform ADL's.

(_) Consult with PT/OT regarding necessary exercises/assistive devices.

(_) Range of motion to____________ extremities ____________ times a day.

(_) Splints to _________________. Apply during __________. Remove for _______________.

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

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