Chapter 2 NHA

8/2/2019 Chapter 2 NHA

1/59

Ma. Christina B. Celdran Oraa, RN MAN


2/59

Is an observation to gather data while the cli

performing common or routine activitie


3/59

PHYSICAL ACTIVITIES OF DAILY LIVING ( PADL)

Describe a typical day for you, starting from the time you wake the time you go to bed.

Do you need assistance with any activities of daily living? (if yeassistance readily available?

Do you socialize, meet, or talk with people outside your house odaily basis?

Does your schedule change on certain days or on weekend? Des


4/59


5/59

Metro Manila DevelopmentScreening Test


6/59

To determine early serious developmental delays

Dr. William K. Frankenburg

Modified and standardized by Dr. Phoebe D. Williams

to MMDST

Developed for health professionals (MDs, RNs, etc)


7/59

It is not an intelligence test

For testing developmental delays in infant and chil

Children 6 years and below

Evaluates 4 aspects of development


8/59


9/59

MMDST manual

test Form

bright red yarn pom-pom

rattle with narrow handleeight 1-inch colored wooden blocks

(red, yellow, blue green)

small clear glass/bottle with 5/8 in

opening

small bell with 2 inch-diameter m

rubber ball 12 inches in circumf

cheese curls

pencil


10/59


11/59

in Activities Daily Living


12/59

Most appropriate instrument to assess functional status as a

measurement of the clients ability to perform activities of dail

independently.Clinicians typically use the tool to detect problems in perform

activities of daily living and to plan care accordingly


13/59

The instrument is most effectively used among older

adults in a variety of care settings, when baseline

measurements, taken when the client is well, are comparedperiodic or subsequent measures.


14/59

STRENGTHS AND LIMITATIONS

It does not assess more advanced activities of daily livin

is sensitive to changes in declining health status, it is

limited in its ability to measure small increments of changeseen in the rehabilitation of older adults.


15/59

The Index ranks adequacy of performance in thsix functions of:

Bathing

Dressing

Toileting

Transferring Continence

feeding.

6 - full function

4 moderate impairme

2 or less - severe functimpairment.


16/59

BARTHEL INDEX


17/59

GENERAL

The Index should be used as a record of what a patient does

NOT as a record of what a patient could do .

The main aim is to establish degree of independence from

help.

The need for supervision renders the patient not independent


18/59

A patient's performance should be established using the best

available evidence. Asking the patient, friends/relatives, and nur will be the usual source.

Usually the performance over the preceding 24 48 hours is

important, but occasionally longer periods will be relevant.


19/59

Bowels (preceding week)

0 - If needs enema from nurse, then 'incontinent.'

1 - Occasional' = once a week.

2 - continence

Bladder (preceding week)

'Occasional' = less than once a day.

A catheterized patient who can completely manage the catheter alone is reg

'continent.'Grooming (preceding 24 48 hours)

Refers to personal hygiene: doing teeth, fitting false teeth, doing hair, shavin

washing face. Implements can be provided by helper.


20/59

Toilet use

Should be able to reach toilet/commode, undress sufficiently, clean self, dress, an

leave.

'With help' = can wipe self and do some other of above.

Feeding

Able to eat any normal food (not only soft food). Food cooked and served by oth

but not cut up.

'Help' = food cut up, patient feeds self. Transfer

From bed to chair and back.

'Dependent' = NO sitting balance (unable to sit); two people to lift.


21/59

Major help' = one strong/skilled, or two normal people. Can si 'Minor help' = one person easily, OR needs any supervision for

Mobility Refers to mobility about house or ward, indoors. May use aid. I

wheelchair, must negotiate corners/doors unaided. 'Help' = by one untrained person, including supervision/moral

support.

Dressing Should be able to select and put on all clothes, which may be ad 'Half' = help with buttons, zips, etc. ( check! ), but can put on som

garments alone.


22/59

Stairs

Must carry any walking aid used to be independent.

Bathing

Usually the most difficult activity. Must get in and out unsupervised, and wash self. Independent in shower

independent' if unsupervised /unaided.


23/59

)


24/59

RATIONALE

This tool is valuable for evaluating patients with early

stage disease, both to assess the level of disease and to

determine the patient's ability to care for him- or herself


25/59

These skills are considered more complex than the ba

activities of daily living as measured by the Katz Index ADLs

The instrument is most useful for identifying how a

person is functioning at the present time , and to iden

improvement or deterioration over time.


26/59

Women are scored on all 8 areas of function;

historically, for men, the areas of food preparation,housekeeping, laundering are excluded.

Clients are scored according to their highest level of functionin

that category.

A summary score ranges from 0 (low function, dependent) to 8(high function, independent) for women, and 0 through 5 for men.


27/59

This instrument is intended to be used among older adults, a

can be used in community or hospital settings.

The instrument is not useful for institutionalized older adults

It can be used as a baseline assessment tool and to compare

baseline function to periodic assessments.


28/59

Operates telephone on own initiative; looks up

and dials numbers....................................................1

Dials a few well-known numbers............................1

Answers telephone, but does not dial...................1

Does not use telephone at all...................................0


29/59

Takes care of all shopping needs independently.........1

Shops independently for small purchases ..................0

Needs to be accompanied on any shopping trip .. 0Completely unable to shop .........................................0


30/59

Plans, prepares, and serves adequate meals independently...1

Prepares adequate meals if supplied with ingredients........0

Heats and serves prepared meals or prepares meals

but does not maintain adequate diet ........................0

Needs to have meals prepared and served ....................0


31/59

Maintains house alone with occasion assistance (heavy work)..

Performs light daily tasks such as dishwashing, bed making

Performs light daily tasks, but cannot maintain acceptable level of cle

Needs help with all home maintenance tasks ....................1

Does not participate in any housekeeping tasks.................0


32/59

Does personal laundry completely...................................1

Launders small items, rinses socks, stockings, etc .........1

All laundry must be done by others .................................0


33/59

Travels independently on public transportation or drives own care....

Arranges own travel via taxi, but does not otherwise use public trans

Travels on public transportation when assisted or accompanied by

another....1

Travel limited to taxi or automobile with assistance of another....0

Does not travel at all ...............0


34/59

.Is responsible for taking medication in correct

dosages at correct time ........................................1

Takes responsibility if medication is prepared in

advance in separate dosages................................0

Is not capable of dispensing own medication...................0


35/59

Manages financial matters independently (budgets, writes

checks, pays rent and bills, goes to bank); collects and keeps track of

income..1

Manages day-to-day purchases, but needs help with

banking, major purchases, etc ................................1

Incapable of handling money ............................................0


36/59

IADL with four scales that measured domains of functional status,

Physical Classification ( 6-point rating of physical health),

Mental Status Questionnaire (10-point test of orientation and

memory),

Behavior and Adjustment rating scales (4-6-point measure of

intellectual, person, behavioral and social adjustment),

and the PSMS (6-item ADLs).


37/59

:

The identification of new disabilities in these functional domains

warrants intervention and further assessment to prevent ongoing de

and to promote safe living conditions for older adults.

If using the Lawton IADL tool with an acute hospitalization, nurshould communicate any deficits to the physicians and social

workers/case managers for appropriate discharge planning.


38/59

A S S I G N M E N T V I D E O P R E S E N TAT I O N

4 TO 5 G R O U P S


39/59


40/59

Gravida (G) - number of pregnancy

Para (P) past pregnancy that have reached viability

Nulligravida

Abortion

Miscarriage


41/59

Problems withinfertility

Dates of previouspregnancies

Infant weightLength of labor

Womans perc

of past pregnanc

labor and deliver

herself and effecher family

Types of deliveries

Multiple births

Abortions

Maternal, fetal andneonatal complications

Past Obstetrics History


42/59


43/59


44/59

Appearance and evaluation of color.

Pulse

Grimace or reflex irritability.

Activity

Respiratory effort


45/59

Auscultate the heart rate for 1 full minute

Measure the degree of respiratory effort

Evaluate muscle tone by attempting to strengthen each proximity individually.

Evaluate the newborns reflex irritability. Use a flicking motion of two fingers

the newborns sole to reflex irritability Inspect the newborns color.


46/59


47/59

The following list illustrates the content of a complete review of systems


48/59

Average weight,

weight lossGain

general state of healthsense of well-being

Strength

ability to conduct usual

activities

exercise tolerance


49/59

Rash, itching

Pigmentation

moisture or dryness

changes in hair growth or loss

nail changes

SKIN/BREAST

Breast lumps

Tenderness

Swelling

nipple discharge


50/59

Headaches

Vertigo

lightheadedness, injury

E Y E S / E A R S / N O S E / M O U T H / T H R O AT

Vision

double visiontearing

blind spotspain


51/59

Nose bleeding

Colds

Obstruction

discharge

Dental difficulties

gingival bleeding, dentures

EYES/EARS/NOSE/MOUTH/THROAT

Neck stiffness

Pain

Tenderness

masses in thyroid or othe

areas


52/59

Precordial pain,substernal distress,palpitations., syncopedyspnea on exertionOrthopneanocturnal paroxysmal dyspnea

CARDIOVASCULAR

EdemaCyanosisHypertensionheart murmurs

varicosities,phlebitis, claudication


53/59

Pain

shortness of breath

Wheezing

Stridor

respiratory infections

RESPIRATORY

cough

hemoptysis,

tuberculosis

fever or night sweats


54/59

Appetite

Dysphagia

Indigestion

abdominal pain

Heartburn

nausea, vomiting

hematemesis,

GASTROINTESTINAL

Jaundiceconstipation or diarrhea

abnormal stools flatulence

Hemorrhoids

recent changes in bowel

habits


55/59

acute retention

incontinence

Libido potenc

genital stores,

venereal disea

GENITOURINARY

Urgency frequency infections

Nephritishesitancy

change in size of streamdribbling

dysuria,nocturia,hematuria,

polyuria, oliguria,Stonescolor of urine,


56/59

Pain

Swelling

rednessheat of muscles or joints,

MUSCULOSKELETAL

limitation of motion,

muscular weakness,

Atrophy Cramps


57/59

Convulsions

Paralyses

Tremor

Incoordination

parathesias

NEUROLOGIC/PSYCHIATRIC

Predominant mood

"nervousness" (define)

emotional problems

previous psychiatric care

unusual perceptions,


58/59

Reactions to drugs,

Food and insects,

skin rashes

trouble breathing

ALLERGIC/ IMMUNOLOGICLYMPHATIC/ENDOCRINE

Anemia

bleeding tendency, previou

transfusions and reactions,

Rh incompatibility


59/59

GRACIAS A TODOS !!

Video Presentation is due on Friday

April 28, 2012

At 11:00am; Nursing Office

Chapter 2 NHA

Documents

Transcript of Chapter 2 NHA