RNSG 1301 Raising the Bar for Success_ Functional Ability _First Semester 2020 – El Centro Functional Ability How does a nurse assess a patient’s functional ability? • Objective vs subjective • IMPACT • Functional Independence Measure (FIM) o Minimum data set of 18 self-care items (eating, bathing, grooming, dressing, etc) o Addresses transfers and ability to ambulate and climb stairs o Also communication and social cognition items o Scoring based on 7-point scale • PULSES profile o Assesses physical condition, upper and lower extremity functions, sensory function, bowel & bladder function, & situational factors • Barthel Index o Measure pt’s level of independence in ADLs, continence, toileting, transfers, & ambulation • Patient Evaluation Conference System (PECS) o 15 categories, a comprehensive assessment scale that includes: meds, pain, nutrition, use of assistive devices, psychological status, vocation, & recreation What is the definition of functional ability? • Physical, psychological, cognitive, and social ability to carry on normal activities of life Know the difference a primary functional ability deficit and secondary functional ability deficit. • Primary o Genetic, injury, trauma, or disease in early life ▪ Autism, cerebral palsy, fetal alcohol syndrome, Down, Duchennes’ MD, malnutrition, fetal drug exposure • Secondary o Progressive, musculoskeletal, or neurological ▪ MS, rheumatoid arthritis, CVA, Parkinson’s, Alzheimer’s What is the difference between Basic Activities of Daily Living and Instrumental Activities of Daily Living? • Basic – personal care and mobility o Eating, bathing, dressing, & toileting • Instrumental – complex skills needed to live in community o Housekeeping, meal prep, finances, & transportation How does age relate to functional ability? • Older age a risk factor for impaired functional ability How does sensory perception relate to functional ability? • In order to properly carry out basic and instrumental, sensory perception needs to be intact or safety issues could arise. How does having poor vision affect a person’s ability to function? • Lack of vision impairs the patient’s ability to properly carry out I/B ADLs • Coping with vision loss can be difficult • Strategies for adapting to environment is needed for carrying out ADLs. • Assistance (people or devices) might be needed What are the domains of function al ability and how do they relate to patient care? • Psychological – coping, manage relationships • Physical – mobility, driving, cleaning, cooking
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RNSG 1301 Raising the Bar for Success_Functional Ability_First Semester 2020 – El Centro | Raising the Bar for Success_Functional Ability_First Semester
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RNSG 1301 Raising the Bar for Success_Functional Ability_First Semester 2020 – El Centro Functional Ability How does a nurse assess a patient’s functional ability? • Objective vs subjective • IMPACT • Functional Independence Measure (FIM) o Minimum data set of 18 self-care items (eating, bathing, grooming, dressing, etc) o Addresses transfers and ability to ambulate and climb stairs o Also communication and social cognition items o Scoring based on 7-point scale -- - - - - - - - - - - - - - - - - - - - - Older age a risk factor for impaired functional ability How does sensory perception relate to functional ability? • In order to properly carry out basic and instrumental, sensory perception needs to be intact or safety issues could arise. How does having poor vision affect a person’s ability to function? • Lack of vision impairs the patient’s ability to properly carry out I/B ADLs • Coping with vision loss can be difficult • Strategies for adapting to environment is needed for carrying out ADLs. • Assistance (people or devices) might be needed What are the domains of functional ability and how do they relate to patient care? • Psychological – coping, manage relationships • Physical – mobility, driving, cleaning, cooking• Cognitive – knowledge of household products and their use, ability to read menu • Social – communication, relationship, what to do in emergency, when/who to ask for help - - - - - - - - - - - - - - - - - - - - -w does a nurse assist a patient who cannot feed themselves, what should be considered when feeding a patient? • Helping hand • Swallowing ability What nursing care is involved for a patient who has had a stroke and has dysphagia? • Speech therapy • Modified diet until swallowing ability progresses • Thickened liquids What nursing actions are necessary for a patient who has a nursing diagnosis of self care deficit related to hygiene? • Care for skin, hair, nails, mouth, teeth, and perineal area • Identify culture/spiritual variations in habits and behaviors • SES & finances often define hygiene options available • Developmental levelWhat are the essential elements to a nursing care plan for a patient who is unconscious? • Frequent eye care (q4h) to keep eye moist and prevent corneal ulceration o Saline/artificial tears as ordered o Protective eye shield to keep eye closed • RN assumes responsibility for pt. until basic reflexes return and pt. becomes conscious and oriented (MedSurg, p1942) o Maintain airway (positioning, suction, oral hygiene, chest PT) o Protect pt. (pad side rails, ensure pt. dignity, do not speak negatively in presence) o Maintain Fluid balance and manage nutritional needs o Mouth care o Skin & Joint integrity o Preserving Corneal integrity (above) o Maintaining Body Temp o Preventing Urinary Retention o Promoting Bowel Function o Restoring Health Maintenance o Meeting Family needs o Monitoring/Managing Potential Complcations What are the main nursing considerations for a patient with Down Syndrome? • Safety, ADLs, IADLs • Provide choices and autonomy What outcomes can be expected for patient with Down Syndrome? • Can become active, productive adults in society; can live independently • Acute leukemia risk is 10-20x greater than other children • w/ incr. life expectancy, Alzheimer risk is also higherWhich healthcare team members are necessary to include on a care plan for a patient with Down Syndrome? • PT,OT What is important to consider when caring for a patient with Alzheimer’s Disease in regards to safety and falls. • Familiar environment • Routine What nursing intervention are related to caring for a patient with Alzheimer’s Disease? - - - - - - - - - - - - - - - - - Who is most likely affected by MS? (age/gender) What are the nursing interventions when caring for a patient with MS?When functional ability is negatively affected, how does a nurse implement the nursing process to adequately provide care to the patient?
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