FORM FOR HOLT WELLNESS ASSESSMENT TOOL PATIENT WORK SHEET ASSESSMENT
nursing care plan 을 작성하기 위해 실제 환자를 대상으로 조사하였음
1. Demographic Data
2. ACTIVITY PATTERN
3. EATING PATTERN
4. SLEEPING PATTERNS
5. CARDIOVASCULAR DISEASE RISK EVALUATION
6. STRESS, PSYCHOSOCIAL SUPPORT, SPIRITUALITY, FAMILY
7. FAMILY HISTORY/GENETIC RISKS FOR LONGEVITY/WELLNESS
8. HUMAN VICES
9. OVERALL SUMMARY PLAN OF CARE
10. Nursing Care Plan
11. Data Collection
12. Nursing Assessment
13. Education and Discharge Planning
Attach your subject’s 4 day activity log
What is your general Health? __no significant loss or gain weight, no cold, illness, energy is high______________________________
Practice safe sex? __yes____________ Is your sex life acceptable/adequate? yes
Sun protection- sunscreen, hats (effectively) __wear sun block____________________
Is your energy level effective for daily activities? Yes energy level is always high
Do you have any pain; does it limit your ADLs in any way? no
Elimination Pattern , regular BM __normal diet per day___________________
Exercise: exercise three days a week
Exercise(vigorous, continuous) 3-5 X/wk for 20-30 mins. _ yes____________________
Sedentary behaviors - TV, computer, video game activities ___yes__________
Summary of Readiness for Exercise Questionnaire: _Normal diet in a day with proportioned nutrient meal and exercise three days a week___________________
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