2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e.pdf

9/15/24, 2:28 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e Figure 2.2 Activities of Daily Living (ADLs) Instrumental Activities of Daily Living (IADL) are more complex daily tasks that allow patients to function...

9/15/24, 2:28 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e Figure 2.2 Activities of Daily Living (ADLs) Instrumental Activities of Daily Living (IADL) are more complex daily tasks that allow patients to function independently such as managing finances, paying bills, purchasing and preparing meals, managing one’s household, taking medications, and facilitating transportation. See Figure 2.3 for an illustration of IADLs. Assessment of IADLs is partic- ularly important to inquire about with young adults who have just moved into their first place, as well as with older patients with multiple medical conditions and/or disabilities. Previous: 2.7 Family Health History Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 2/20 9/15/24, 2:28 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e Figure 2.3 Instrumental Activities of Daily Living (IADLs) Information obtained when assessing functional health provides the nurse a holistic view of a patient’s human response to illness and life conditions. It is helpful to use an assessment framework, such as Gordon’s Functional Health Patterns, to organize inter- view questions according to evidence-based patterns of human responses. Using this framework provides the patient and their family members an opportunity to identify health-related concerns to the nurse that may require further in-depth assessment. It also verifies patient understanding of conditions so that misperceptions can be clarified. This framework includes the following categories: Nutritional-Metabolic: Food and fluid consumption relative to metabolic need Elimination: Excretion including bowel and bladder Activity-Exercise: Activity and exercise Sleep-Rest: Sleep and rest Cognitive-Perceptual: Cognition and perception Role-Relationship: Roles and relationships Sexuality-Reproductive: Sexuality and reproduction Coping-Stress Tolerance: Coping and effectiveness of managing stress Value-Belief: Values, beliefs, and goals that guide choices and decisions Previous: 2.7 Family Health Self-Perception and History Self-Concept: Self-concept and mood state Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 3/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e Health Perception-Health Management: A patient’s perception of their health and well-being and how it is managed. This is an umbrella category of all the categories above and underlies performing a health history. The functional health section can be started by saying, “I would like to ask you some questions about factors that affect your ability to function in your day-to-day life. Feel free to share any health concerns that come to mind during this discussion.” Focused in- terview questions for each category are included in Table 2.8. Each category is further described below. Nutrition The nutritional category includes, but is not limited to, food and fluid intake, usual diet, financial ability to purchase food, time and knowledge to prepare meals, and appetite. This is also an opportune time to engage in health promotion discussions about healthy eating. Be aware of signs for malnutrition and obesity, especially if rapid and excessive weight loss or weight gain have occurred. Life Span Considerations When assessing nutritional status, the types of questions asked and the level of detail depend on the developmental age and health of the patient. Family members may also provide important information. Infants: Ask parents about using breast milk or formula, amount, frequency, supple- ments, problems, and introductions of new foods. Pregnant women: Include questions about the presence of nausea and vomiting and intake of folic acid, iron, omega-3 fatty acids, vitamin D, and calcium. Older adults or patients with disabling illnesses: Inquire about the ability to pur- chase and cook their food, decreased sense of taste, ability to chew or swallow foods, loss of appetite, and enough fiber and nutrients. For more information about nutrition, visit the “Nutrition” chapter in Open RN Nursing Fundamentals. Previous: 2.7 Family Health History Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 4/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e Elimination Elimination refers to the removal of waste products through the urine and stool. Health care professionals refer to urinating as voiding and stool elimination as having a bowel movement. Familiar terminology may need to be used with patients, such as “pee” and “poop.” Constipation commonly occurs in hospitalized patients, so it is important to assess the date of their last bowel movement and monitor the frequency, color, and consistency of their stool. Assess urine concentration, frequency, and odor, especially if concerned about urinary tract infection or incontinence. Findings that require further investigation include dy- suria (pain or difficulty upon urination), blood in the stool, melena (black, tarry stool), constipation, diarrhea, or excessive laxative use. Life Span Considerations When assessing elimination, the types of questions asked and the level of detail de- pends on the developmental age and health of the patient. Toddlers: Ask parents or guardians about toilet training. Toilet training takes several months, occurs in several stages, and varies from child to child. It is influenced by culture and depends on physical and emotional readiness, but most children are toilet trained between 18 months and three years. Older Adults: Constipation and incontinence are common symptoms associated with aging. Additional focused questions may be required to further assess these issues. For more information about elimination, visit the “Elimination” chapter in Open RN Nursing Fundamentals. Mobility, Activity, and Exercise Previous: 2.7 Family Health History Mobility refers to a patient’s ability to move around (e.g., sit up, sit down, stand up, walk). Activity and exercise refer to informal and/or formal activity Next: (e.g.,2.9 walking, Review ofswimming, Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 5/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e yoga, strength training). In addition to assessing the amount of exercise, it is also impor- tant to assess activity because some people may not engage in exercise but have an ac- tive lifestyle (e.g., walk to school or work in a physically demanding job). Findings that require further investigation include insufficient aerobic exercise and iden- tified risks for falls. Life Span Considerations Mobility and activity depend on developmental age and a patient’s health and illness status. With infants, it is important to assess their ability to meet specific developmental milestones at each well-baby visit. Mobility can become problematic for patients who are ill or are aging and can result in self-care deficits. Thus, it is important to assess how a patient’s mobility is affecting their ability to perform ADLs and IADLs. For more information, visit the “Mobility” chapter in Open RN Nursing Fundamentals. Sleep and Rest The sleep and rest category refers to a patient’s pattern of rest and sleep and any associ- ated routines or sleeping medications used. Although it varies for different people and their life circumstances, obtaining eight hours of sleep every night is a general guideline. Findings that require further investigation include disruptive sleep patterns and reliance on sleeping pills or other sedative medications. Life Span Considerations Older Adults: Disruption in sleep patterns can be especially troublesome for older adults. Assessing sleep patterns and routines will contribute to collaborative interven- tions for improved rest. Previous: 2.7 Family Health History For more information, visit the “Sleep and Rest” chapter in Open RN Nursing Fundamentals. Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 6/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e Cognitive and Perceptual The cognitive and perceptual category focuses on a person’s ability to collect informa- tion from the environment and use it in reasoning and other thought processes. This category includes the following: Adequacy of vision, hearing, taste, touch, feeling, and smell Any assistive devices used Pain level and pain management Cognitive functional abilities, such as orientation, memory, reasoning, judgment, and decision-making If a patient is experiencing pain, it is important to perform an in-depth assessment using the PQRSTU method described in the “Reason for Seeking Health Care” section of this chapter. It is also helpful to use evidence-based assessment tools when assessing pain, especially for patients who are unable to verbally describe the severity of their pain. See Figure 2.4 for an image of the Wong-Baker FACES tool that is commonly used in health care. Figure 2.4 The Wong-Baker FACES Pain Rating Scale. Used with permission from http://www.WongBakerFACES.org. Previous: 2.7 Family Health History Life Span Considerations Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 7/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e Older Adults: Older adults are especially at risk for problems in the cognitive and per- ceptual category. Be alert for cues that suggest deficits are occurring that have not been previously diagnosed. Roles – Relationships Quality of life is greatly influenced by the roles and relationships established with family, friends, and the broader community. Roles often define our identity. For example, a pa- tient may describe themselves as a “mother of an 8-year-old.” This category focuses on roles and relationships that may be influenced by health-related factors or may offer support during illness. Findings that require further investigation include indications that a patient does not have any meaningful relationships or has “negative” or abusive relationships in their lives. Life Span Considerations Be sensitive to cues when assessing individuals with any of the following characteristics: isolation from family and friends during crisis, language barriers, loss of a significant per- son or pet, loss of job, significant home care needs, prolonged caregiving, history of abuse, history of substance abuse, or homelessness. Sexuality – Reproduction Sexuality and sexual relations are an aspect of health that can be affected by illness, ag- ing, and medication. This category includes a person’s gender identity and sexual orien- tation, as well as reproductive issues. It involves a combination of emotional connection, physical companionship (holding hands, hugging, kissing) and sexual activity that im- pact one’s feeling of health. The Joint Commission has defined terms to use when caring for diverse patients. Gender identity is a person’s basic sense of being male, female, or other gender. Gender expression are characteristics in appearance, personality, and behavior that are culturally defined as masculine or feminine. Sexual orientation is the preferred term used when referring to an individual’s physical and/or emotional attraction to the same and/or opposite gender. LGBTQ is an acronym standing for the lesbian, gay, bisexual, transgender, Previous: 2.7 and queer Family Healthpopulation. History It is an umbrella term that generally refers to a group of people who are diverse in gender identity and sexual orientation. It is impor- Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 8/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e tant to provide a safe environment to discuss health issues because the LGBTQ popula- tion experiences higher rates of smoking, alcohol use, substance abuse, HIV and other STD infections, anxiety, depression, suicidal ideation and attempts, and eating disorders as a result of stigma and marginalization. Life Span Considerations Although sexuality is frequently portrayed in the media, individuals often consider these topics as private subjects. Use sensitivity when discussing these topics with different age groups across cultural beliefs while maintaining professional boundaries. For more information, read the Joint Commission’s PDF Field Guide called Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community. Coping-Stress Tolerance Individuals experience stress that can lead to dysfunction if not managed in a healthy manner. Throughout life, healthy and unhealthy coping strategies are learned. Coping strategies are behaviors used to manage anxiety. Effective strategies control anxiety and lead to problem-solving but ineffective strategies can lead to abuse of food, tobacco, al- cohol, or drugs. Nurses teach and reinforce effective coping strategies. Substance Use and Abuse Alcohol, tobacco products, marijuana, and drugs are often used as ineffective coping strategies. It is important to use a nonjudgmental approach when assessing a patient’s use of substances, so they do not feel stigmatized. Substance abuse can affect people of all ages. Make a distinction between use and abuse as you assess frequency of use and patterns of behavior. Substance abuse often causes disruption in everyday function (e.g., loss of employment, deterioration of relationships, or precarious living circumstances) because of2.7 Previous: dependence Family Health on a substance. Action is needed if patients indicate that they History Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 9/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e have a problem with substance use or show signs of dependence, addiction, or binge drinking. Life Span Considerations Some individuals are at increased risk for problems with coping strategies and stress management. Be sensitive to cues when assessing individuals with characteristics such as uncertainty in medical diagnosis or prognosis, financial problems, marital problems, poor job fit, or few close friends and family members. Value-Belief This category includes values and beliefs that guide decisions about health care and can also provide strength and comfort to individuals. It is common for a person’s spirituality and values to be influenced by religious faith. A value is an accepted principle or stan- dard of an individual or group. A belief is something accepted as true with a sense of certainty. Spirituality is a way of living that comes from a set of values and beliefs that are important to a person. The Joint Commission asks health care professionals to re- spect patients’ cultural and personal values, beliefs, and preferences and accommodate patients’ rights to religious and other spiritual services. When performing an assess- ment, use open-ended questions to allow the patient to share values and beliefs they believe are important. For example, ask, “I am interested in your spiritual and religious beliefs and how they relate to your health. Can you share with me any spiritual beliefs or religious practices that are important to you during your stay?” For more information about assessing and providing for patients’ spiritual needs, visit the “Spirituality” chapter in Open RN Nursing Fundamentals. Self-Perception and Self-Concept The focus of this category is on the subjective thoughts, feelings, and attitudes of a pa- tient about themself. Self-concept refers to all the knowledge a person has about them- self that makes up who they are (i.e., their identity). Self-esteem refers to a person’s self- evaluation of Family Previous: 2.7 these Health itemsHistory as being worthy or unworthy. Body image is a mental picture of one’s body related to appearance and function. It is best to assess these items toward Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 10/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e the end of the interview because you will have already collected data that contributes to an understanding of the patient’s self-concept. Factors that influence a patient’s self- concept vary from person to person and include elements of life they value, such as tal- ents, education, accomplishments, family, friends, career, financial status, spirituality, and religion. The self-perception and self-concept category also focuses on feelings and mood states such as happiness, anxiety, hope, power, anger, fear, depression, and control. Life Span Considerations Some individuals are at risk for problems with self-perception and self-concept. Be sen- sitive to cues when assessing individuals with characteristics such as uncertainty regard- ing a medical diagnosis or surgery, significant personal loss, history of abuse or neglect, loss of body part or function, or history of substance abuse. Violence and Trauma There are many types of violence that a person may experience, including neglect or physical, emotional, mental, sexual, or financial abuse. You are legally mandated to re- port suspected cases of child abuse or neglect, as well as suspected cases of elder abuse. At any time, if you or the patient is in immediate danger, follow agency policy and procedure. Trauma results from violence or other distressing events in a life. Collaborative interven- tion with the patient is required when violence and trauma are identified. People re- spond in different ways to trauma. It is important to use a trauma-informed approach when caring for patients who have experienced trauma. For example, a patient may re- spond to the traumatic situation in a way that seems unfitting (such as with laughter, ambivalence, or denial). This does not mean the patient is lying but can be a symptom of trauma. To reduce the effects of trauma, it is important to implement collaborative in- terventions to support patients who have experienced trauma. Loss of Body Part Previous: 2.7 Family Health History A person can have negative feelings or perceptions about the characteristics, function, or limits of a body part as a result of a medical condition, surgery, Next: 2.9trauma, Review ofor mental Body con- Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 11/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e dition. Pay attention to cues, such as neglect of a body part or negative comments about a body part and use open-ended questions to obtain additional information. Mental Health Mental health is frequently underscreened and unaddressed in health care. The mental health of all patients should be assessed, even if they appear well or state they have no mental health concerns so that any changes in condition are quickly noticed and treat- ment implemented. Mental health includes emotional and psychological symptoms that can affect a patient’s day-to-day ability to function. The World Health Organization (2014) defines mental health as “a state of well-being in which every individual realizes their own potential, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community.” Mental illness in- cludes conditions diagnosed by a health care provider, such as depression, anxiety, ad- diction, schizophrenia, post-traumatic stress disorder, and others. Mental illness can dis- rupt everyday functioning and affect a person’s employment, education, and relationships. It is helpful to begin this component of a mental health assessment with a statement such as, “Mental health is an important part of our lives, so I ask all patients about their mental health and any concerns or questions they may have.” Be attentive of critical findings that require intervention. For example, if a patient talks about feeling hopeless or depressed, it is important to screen for suicidal thinking. Begin with an open-ended question, such as, “Have you ever felt like hurting yourself?” If the patient responds with a “Yes,” then progress with specific questions that assess the immediacy and the inten- sity of the feelings. For example, you may say, “Tell me more about that feeling. Have you been thinking about hurting yourself today? Have you put together a plan to hurt your- self?” When assessing for suicidal thinking, be aware that a patient most at risk is some- one who has a specific plan about self-harm and can specify how and when they will do it. They are particularly at risk if planning self-harm within the next 48 hours. The age of the patient is not a factor in this determination of risk. If you believe the patient is at high risk, do not leave the patient alone. Collaborate with them regarding an immediate plan for emergency care. Health Perception-Health Management Previous: 2.7 Family Health History Health perception-health management is an umbrella term encompassing all of the Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 12/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e categories described above, as well as environmental health. Environmental Health Environmental health refers to the safety of a patient’s physical environment, also called a social determinant of health. Examples of environmental health include, but are not limited to, exposure to violence in the home or community; air pollution; and availability of grocery stores, health care providers, and public transportation. Findings that require further investigation include a patient living in unsafe environments. See Table 2.8 for sample focused questions for all categories related to functional health. Table 2.8 Focused Interview Questions for Functional Health Categories Begin this section by saying, “I would like to ask you some questions about factors that affect your ability to function in your day-to-day life. Feel free to share any health concerns that come to mind during this discussion.” Previous: 2.7 Family Health History Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 13/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e Category Focused Questions Nutrition Tell me about your diet. What foods do you usually eat? What fluids do you usually drink every day? What have you eaten in the last 24 hours? Is this typical of your usual eating pattern? Tell me about your appetite. Have you had any changes in your appetite? Do you have any goals related to your nutrition? Do you have any financial concerns about purchasing food? Are you able to prepare the meals you want to eat? Elimination When was your last bowel movement? Do you have any problems with constipation, diarrhea, or incontinence? Do you take laxatives or stool softeners? Do you have any problems urinating, such as frequent urination or burning on urination? Do you ever experience leaking or dribbling of urine? Mobility, Tell me about your ability to move around. Activity, and Exercise Do you have any problems sitting up, standing up, or walking? Do you use any mobility aids (e.g., cane, walker, wheelchair)? Tell me about the activity and/or exercise in which you engage. What Previous: 2.7 Familytype? Health How Historyfrequent? For how long? Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 14/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e Sleep and Rest Tell me about your sleep routine. How many hours of sleep do you usually get? Do you feel rested when you awaken? Do you do anything to wind down before you go to bed (e.g., watch TV, read)? Do you take any sleeping medication? Do you take any naps during the day? Cognitive and Are you having any pain? Perceptual Note: If present, use the PQRSTU method to further assess pain. Are you having any issues with seeing, hearing, smelling, tasting, or feeling things? Have you noticed any changes in memory or problems concentrating? Have you noticed any changes in the ability to make decisions? What is the easiest way for you to learn (e.g., written materials, expla- nations, or learning-by-doing)? Previous: 2.7 Family Health History Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 15/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e Roles and Tell me about the most influential relationships in your life with Relationships family and friends. How do these relationships influence your day-to-day life, health, and illness? Who are the people with whom you talk to when you require sup- port or are struggling in your life? Do you have family or others dependent on you? Have you had any recent losses of someone important to you, a pet, or a job? Do you feel safe in your current relationship? Sexuality- The expression of love and caring in a sexual relationship and Reproduction creation of family are often important aspects in a person’s life. Do you have any concerns about your sexual health? Tell me about the ways that you ensure your safety when engaging in intimate and sexual practices. Coping-Stress Tell me about the stress in your life. Have you experienced a recent loss in your life that has impacted you? How do you cope with stress? Values-Belief I am interested in your spiritual and religious beliefs and how they relate to your health. Can you share with me any spiritual beliefs or religious practices that are important to you? Previous: 2.7 Family Health History Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 16/20 9/15/24, 2:29 PM 2.8 Functional Health and Activities of Daily Living – Nursing Skills – 2e Self- Tell me what makes you who you are. How would you describe Perception yourself? and Self- Concept Have you noticed any changes in how you view your body or the things you can do? Are these a problem for you? Have you found yourself feeling sad, angry, fearful, or anxious? What helps you to feel better when this happens? Have you ever used any tobacco products (e.g., cigarettes, pipes, va- porizers, hookah)? If so, how much? How much alcohol do you drink every week? Have you used cannabis products? If so, how often do you use them? Have you ever used drugs or prescription drugs that were not pre- scribed for you? If so, what type? Have you ever felt you had a problem with any of these substances because they affected your daily life? If so, tell me more. Do you want to quit any of these substances? Many patients have experienced violence or trauma in their lives. Have you experienced any violence or trauma in your life? How has it affected you? Would you like to talk with someone about it? Previous: 2.7 Family Health History Next: 2.9 Review of Body Systems https://wtcs.pressbooks.pub/nursingskills/chapter/2-8-functional-health-and-activities-of-daily-living/ 17/20