Transcript Concept: Functional Ability


Definition: Physical, psychological, cognitive,
and social ability to carry on normal activities
of life
◦ An individuals’ ability to perform the normal daily
activities required to meet basic needs
 Fulfill usual roles within the family, workplace &
community
 Maintain health and well-being
Complete dependence
Fully independent
Physical domain
Psychological
domain
Social domain
Cognitive domain

Sub-concepts:
◦ Basic activities of daily living* (BADLs)
 Personal care and mobility
◦ Instrumental activities of daily living* (IADLs)
 Complex skills needed to live in the community
◦ Functional Impairment
◦ Primary vs. secondary vs. tertiary
 Risk recognition
 Functional assessment
 Care delivery
 What would happen if tertiary prevention is not
implemented?
*both are essential to independent living

Developmental milestones

Acquisition of learning skills

Learning

Perceived ability

Integration of neural/endocrine/musculoskeletal
capacity

Metabolic manifestations to provide energy (Krebs
cycle)
 When
is it likely to be present?
◦ Changes over course of lifespan as a function of
development
◦ In a group discuss the changes that occur.
Infants/young
children
Functional
ability
indicated by:
Young and
middle
adulthood
Older adult
 Risk
recognition
◦ Critical step*
Good
functional
ability
Functional
deficits

Multiple risk factors include:
◦ Developmental abnormalities
◦ Physical or psychological trauma or disease
◦ Social and cultural
 Beliefs
 Perceptions of health
 Physical environment
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◦
◦
◦
◦
◦
Age
Cognitive function
Level of depression
Comorbidities
Socioeconomic factors
Pre-clinical disability
 How
do you recognize a problem?
(What are the attributes):
1. Capacity to perform a specific self-care
behavior
*Actual performance of the behavior
Not simply can or do they, but can they
 under what circumstances?
 with what assistance?
 in what length of time?
Why is it necessary to examine attributes of this concept?


Self-reporting from patient
Performance-based assessment tools:
◦ A functional assessment is a multidimensional and often
interdisciplinary diagnostic process
◦ KATZ Activities of Daily Living,(p.789 Taylor)
 Those activities necessary for well-being,
known as instrumental ADLs
 focus primarily on household chores, (cooking,
cleaning, laundry)
 mobility-related activities (shopping and
transportation)
 cognitive abilities (money management, using the
telephone, and making decisions affective basic
safety and social needs)


Self-reporting from patient
Performance-based assessment tools:
◦ Lawton Scale for Instrumental Activities of
Daily Living (IADLs), page 789, Taylor
 screener that assesses eight domains of
function to evaluate independent living
skills.
◦ Nutrition:
 Mini-Nutritional Assessment (MNA) is
an assessment used to identify adults
65+ who are at risk for malnutrition
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Snellen
Hearing tests
BMI
MMSE
◦ The mini–mental state examination (MMSE) or
Folstein test is a brief 30-point questionnaire test
that is used to screen for cognitive impairment
◦ It is commonly used in medicine to screen for
dementia

Geriatric depression scale
◦ 15-item scale testing for late life depression

Self-care deficit
Impaired mobility
Impaired wheelchair mobility

Others to consider


 Impaired cognition
 Imbalanced nutrition: less than body
requirements
 Ineffective individual coping
 Disturbed sensory perception
 Impaired gas exchange

What does the nurse do?
Social
Early
intervention
is key
Emotional
Cognitive
Goal: optimal
independent
function and
prevention of
decline
Functional
Assessment by
Nurse
Communication
Physical
Management of
functional activity
takes a
multidisciplinary
approach
Positive outcomes:
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
hope
quality of life/well-being
learning effective coping behavior
adaptation to work, environment, and health status
goal achievement
Negative outcomes:
◦
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further disability
increased dependence
increased use of health services
depression
stress

Infants/children

Adults/elderly
CVA
Alzheimer’s disease
Multiple
sclerosis
Parkinson’s
disease
Functional
ability
Down’s
syndrome


Mrs. Rose Finney is an
85-year-old woman
with ovarian cancer.
Case study
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
Break into 4 groups
Develop concept map
A progressive immune-related demyelination
disease of the CNS
Process of Demyelination
 Demyelination: destruction of the fatty and
protein material that surrounds nerve fibers
in the brain & spinal cord
 Results in: impaired nerve transmission
Assessment
◦
◦
◦
◦
◦
◦
◦
◦
◦
Dependent upon location of lesion
Fatigue
Pain
Spasticity
Ataxia: impaired coordination of movements
Incontinence
Exacerbation and remission
Gait & Balance – risk for injury
Impact of disease on physical, social, and emotional
function and on lifestyle
Possible Nursing Diagnoses
 · Impaired physical mobility
 · Risk for injury
 · Impaired bowel and bladder function
 · Impaired verbal communication
 · Disturbed thought processes
 · Ineffective coping
Major goals may include:
 · Promotion of physical mobility
 · Avoidance of injury
 · Achievement of bowel and bladder
continence
 · Promotion of speech and swallowing
mechanisms
 · Improvement in cognitive function
 · Development of coping strengths
 · Improved home maintenance
 · Adaptation to sexual function
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· Promoting physical mobility
 o Exercise with activity and rest
 o Minimizing effects of impaired mobility
· Preventing injury
 o Teach walking with feet wide to
increase base of support
 o Teach to watch the feet while walking
 o Provide assistive devises and
instruction as needed
 o May become necessary for use of
wheelchair
·
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· Enhancing bladder and bowel control
 o Voiding schedule
 o Dietary modifications
· Managing swallowing difficulties
 o Assessment of dysphasia
 o Speech therapy consult for swallow
studies
· Assisting with coping and strengthening of
coping mechanisms


slowly progressing neurologic movement
disorder that eventually leads to disability
associated with decreased levels of
dopamine due to destruction of cells in the
substantia nigra in the basal ganglia; this
effects the neurotransmission of impulses
Manifestations:
 tremor, rigidity, bradykinesia, postural instability,
depression and other psychiatric changes, dementia,
autonomic symptoms, sleep disturbances,
 exact cause unknown, possibly involving environmental and
genetic factors
Management of Parkinson Disease
 Directed at controlling symptoms & maintaining
functional independence
◦ Exercise and ambulation
 Non-traditional; but aggressive physical therapy is becoming
popular
◦
◦
◦
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OT collaboration
Injury prevention
Assess sleeping pattern
Nutrition
 As disease progresses, PEG tube/enteral nutrition may be
required
◦ Communication
◦ ST collaboration
◦ Psychosocial support

Parkinson’s Disease—Possible nursing
diagnoses
◦ Impaired physical mobility and risk for
activity intolerance
◦ Self-care deficits
◦ Risk/actual Imbalanced nutrition
◦ Constipation
◦ Impaired verbal communication
◦ Ineffective coping/compromised family
coping
◦ Risk for injury
Parkinson’s Disease—Planning
 Major goals may include
◦ improved functional ability
 maintaining independence in activities of
daily living
 achieving adequate bowel elimination
 attaining and maintaining acceptable
nutritional status
 achieving effective communication
◦ developing positive individual and family
coping skills
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The most common cause of dementia
A chronic, progressive, degenerative brain
disorder
Characterized by loss of memory,
judgment, visual-spatial perception with
changes in personality
Interventions in Alzheimer’s Disease
◦ Provide cognitive restructuring and memory training.
◦ Structure the environment to increase client’s ability to
function.
◦ Provide consistency, orientation, and validation therapy.
◦ Promote independence in activities of daily living.
◦ Promote bowel and bladder continence.
◦ Assist with facial recognition as the disease progresses
to prosopagnosia (an inability to recognize oneself and
other familiar faces)
◦ Promote communication with clear, short sentences

“Stroke”
◦ Prolonged interruption of blood supply
through the cerebral artery
 Brain cells begin to die in 3 to 7
minutes w/o O2…. IRREVERSIBLE
◦ Types:
 1. hemorrhagic
 2. ischemic (thrombolytic)
◦ Uncontrollable risk factors
 1. age
 2. sex
 3. race
 4. genetics
◦ Controllable risk factors
 1. HTN
 2. afib
 3. increased lipids
 4. smoking
 5. obesity
Long term results
 1. motor function changes
 2. flaccidity to spastic limbs
 3. aphasia
 expressive
 receptive
 4. hemaniopia
 5. impaired judgment
 6. unilateral neglect
◦ Nursing
 1. meds as ordered
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


Antihypertensives
Antilipidemic
Anticoagulants
Antiplatelet
 2. Swallowing precautions
 3. Contacting community resources-patient/family
education
 4. Physical/occupational/speech therapies


Measurement of functional ability has
become increasingly important as people
live longer while developing chronic illness
and infirmities
Instead of assessing a patient with regard
to “How old?” it is better to consider “How
functional?”

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Key issues that affect function: IMPACT
(impairment, memory, physical, access,
clarity, time)
Environmental factors strongly influence
responses to BADL and IADL measures

One of the most important dimensions of
function ability is dependence;
◦ dependence indicates whether an individual
needs or uses the assistance of another person or
special equipment to accomplish the task


It is common that patients with functional
deficits require the services of a variety of
health care professionals
While major improvements in the older
adult's functional abilities may not be
possible, even small changes may
significantly improve the individual's quality
of life.
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Why is it necessary that we examine attributes of
this concept?
Can you give me an example of when the condition
is likely to be present?
What would happen if tertiary prevention is not
implemented?
How would you apply this concept to patient’s
whose cause of functional inability is from a
primary problem (such as a trauma) versus a
secondary problem (such as a result of aging)

Which of the following is not a
secondary problem of functional
ability?
◦ A.
◦ B.
◦ C.
◦ D.
Disease
Age
Down’s syndrome
Trauma

Which of the following is not a domain
of functional ability?
◦ A.
◦ B.
◦ C.
◦ D.
Psychological domain
Social domain
Cognitive domain
Spatial domain

All of the following are antecedents to
functional ability except which:
◦ A.
◦ B.
◦ C.
◦ D.
Developmental milestones
Acquisition of learning skills
Learning
Capacity to perform

The two basic categories of functional
ability are basic activities of daily
living and instrumental activities of
daily living.
◦ A. True
◦ B. False