Nursing Care Plan Work Sheet
Subjective Data: (Patient’s reason for seeking healthcare, their CC/HPI, PQRST is OK here)
 Reports mild pain in his RLE
 reports slight numbness in his feet.
 He reports living alone with 3 small dogs in a two-story home. the home has marble floors, but there are throw rugs near the
doors and in the bathrooms.
Objective Data: (What is assessed)
Vital Signs: T 37C, P 76, RR 18, O2 94%, BP 112/70.
 has a history of peripheral neuropathy
 has mild bruising on his lower extremities
 has a healed incision from a right total knee replacement (TKR) surgery from 4 weeks earlier.
 Uses a cane and has a gait that appears unsteady.
NANDA Statement: Nursing Diagnosis r/t (underlying etiology) as evidenced by (most indicative symptoms and assessment)
Risk for falls r/t use of throw rugs, having an unsteady gait, and living alone as evidenced by the mild bruising in the lower
extremities and unsteady gait
Nursing Outcome Classification (NOC): Nursing Outcome (only pick one of these. Remember, make it a realistic goal with
realistic time frame.) e.g. “By the end of the 12-hour shift, the patient will __________.”
By the end of the 12-hour shift, the patient will adapt environment to minimize the incidence of falls.
Nursing Interventions (include the citation in references)(no more than one assessment intervention, then at least two action
interventions- what is the nurse actually doing to help this patient get better.)
1. Teach the client what to do if he falls and cannot get up, and make sure he has a personal emergency response
system or a mobile phone that is available from the floor (Greenberg, 2020, p. 375)
2. Teach the client how to safely ambulate at home, including using safety measures such as handrails in bathroom,
reaching for items on high shelves and avoiding carrying things or performing other tasks while walking.
(Greenberg, 2020, p. 376)
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3. Use a valid and reliable fall risk assessment tool to assess the client risk for falling. The Hendrich II Fall Risk
Model is quick to administer and provides a determination of risk for falling based on gender, mental and emotional
status, symptoms of dizziness, and known categories of medications increasing risk. This tool screens for primary
prevention of falls and is integral in a postfall assessment for the secondary prevention of falls. (Greenberg, 2020, p. 371)
Reference: If using Ackley, or other edited book, cite the author of the chapter in an edited book using APA form
Greenberg, SA. (2020). Risk for falls. In B. J Ackley, G. B. Ladwing, M. B. Flynn Makic, M. M.-K., & M. Zanotti (Eds,), Nursing
diagnosis handbook: An evidence-based guide to planning care (12th ed., pp. 371-376). Elsevier.
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