Nursing 211 – Introduction to Therapeutic Nursing Interventions
FUNCTIONAL ASSESSMENT
GUIDELINES FOR FUNCTIONAL ASSESSMENT
1. Describe the circumstances and setting in which you completed the assignment. How did you prepare your client and yourself for the assignment?
2. Discuss each area of the assessment on the first two pages (self-esteem/self-concept, activity/exercise, etc.) in a short paragraph. Then discuss the IADL assessment. How did the client score in each area, and overall? What does the score mean? Given what you know about your client, does the assessment accurately reflect your client’s status? What are the strengths and weaknesses of the client? Were there any factors that interfered with the assessment, or that you think may make the results inaccurate?
3. Reflections: How did you feel completing this assignment? How did the client react?
4. Self-evaluation: What did you do well? What could you improve on or do differently next time?
Self-Esteem/Self Concept: Education (last grade completed, other significant training); financial status (income adequate for lifestyle and /or health concerns); and values and belief system (religious and perception of personal strengths).
Activity/Exercise: A daily profile reflecting usual daily activities. Ability to perform ADLs- independent or needs assistance. Ability to tolerate activity or to use prostheses or mobility aids. Leisure activities enjoyed and exercise pattern (type, amount per day or week, warm-up session, body’s response to exercise).
Sleep/Rest: Sleep patterns, any sleep aids, or daytime naps.
Nutrition/Elimination: All foods and beverages taken over the last 24 hours: “Is that menu typical?” Eating habits and current appetite. “Who buys food and prepares food? Are finances adequate for food? Who is present at mealtimes? Any food allergy or intolerance?” Daily intake of caffeine (coffee, tea, cola drinks).
Interpersonal Relationships/Resources: Social roles: “What’s your role in your family? How would you say you get along with family and coworkers?” Support systems composed of family and significant others: “To whom could you go for support with a problem at work, with your health, or a personal problem?” Amount of time spent alone: “Is this pleasurable or isolating?”
Coping and Stress management: Stresses in life now and in the past year, any change in lifestyle or any current stress, and any steps taken to relieve stress?
Personal Habits: Alcohol: “When was your last drink of alcohol? How much did you drink at that time? Have you ever had a drinking problem?” Smoking: “Do you smoke? At what age did you start? How many packs do you smoke per day? How many years have you smoked?” Street drugs: “Have you ever tried any drugs such as marijuana, cocaine, amphetamines, or barbiturates? How often do you use these drugs? How has usage affected your work or social relationships?”
Environment/Hazards: Housing and neighborhood (live alone, know neighbors, safety of area, adequate heat and utilities, access to transportation, involved in community services); and environmental health (hazards in workplace, hazards at home, use of seatbelts, geographic or occupational exposures, travel or residence in other countries).
INSTRUMENTAL ACTIVITIES OF
DAILY LIVING
Evaluation of autonomy of the older adult helps in making decisions with family and clients about client care. This scale can be an effective therapeutic tool in planning care and in identifying strengths and limitations of the older adult.
The instrumental activities of daily living, (IADL), has eight categories of activities which help the nurse determine the client’s level of functioning beyond simple physical tasks of self care. The highest possible sore for females is 8 while the highest possible score for males is 5. For males, the possible score for each item in a category appears in the first column at the right of the category items. For females, the possible score for each item in a category appears in the second column at the right of the category items. The highest possible score for a category is 1 while the lowest possible score is 0.
Give a score for each category, choosing the category item which best reflects the client’s level of functioning. For example, A: Ability to Use Telephone = 1. Item chosen: #2-Dials a few well-known numbers.
Sum the score. For females:
a score of 7-8 = high level of independence
5-6 = moderate level of independence
3-4 = moderate level of dependence
1-2 = dependence
For males:
a score of 5 = independence
4 = moderate independence
3 = minimal independence/dependence
2 = moderate dependence
1 = dependence
While a summed score will give an overall picture of the level of independence in IADL, each category should be considered separately to determine the rehabilitative needs of clients.
Modified
from Lawton M and Brody E: Assessment of older people: self maintaining and
instrumental activities of daily living.
The Gerontologist 9: 1969.
Male Female
Category Score Score
________________________________________________________________________
A. Ability to use telephone 1 1
1. Operates telephone on own
Initiative-looks up and dials numbers
etc.
2. Dials a few well-known numbers 1 1
3. Answers telephone but does not dial 1 1
4. Does not use telephone at all. 0 0
B. Shopping
1. Takes care of all shopping needs
Independently. 1 1
2. Shops independently for small purchases. 0 0
3. Needs to be accompanied on any shopping
trip. 0 0
4. Completely unable to shop. 0 0
C. Food preparation
1. Plans, prepares and serves adequate
meals independently. 1
2. Prepares adequate meals if supplied
with ingredients. 0
3. Heats and serves prepared meals, or
Prepares meals but does not maintain
adequate diet. 0
4. Needs to have meals prepared and served. 0
D. Housekeeping
1. Maintains house alone or with occasional
Assistance (e.g. “heavy work-domestic help”) 1
2. Performs light daily tasks such as dishwashing,
bedmaking. 1
3. Performs light daily tasks but can’t maintain
acceptable level of cleanliness. 1
4. Needs help with all home maintenance tasks. 1
5. Does not participate in any housekeeping
tasks. 0
E. Laundry
1. Does personal laundry completely. 1
2. Launders small items-rinses socks, stockings
etc. 1
3. All laundry must be done by others. 0
F. Mode of Transportation
1. Travels independently on public
Transportation or drives own car 1 1
2. Arranges own travel via taxi, but
does not otherwise use public
transportation. 1 1
3. Travels on public transportation when
assisted or accompanied by another. 0 1
4. Travel limited to taxi or automobile with
assistance of another. 0 0
5. Does not travel at all. 0 0
G. Responsibility for own Medications
1. Is responsible for taking medication
in correct dosages at correct time. 1 1
2. Takes responsibility if medication is
prepared in advance in separate dosages. 0 0
3. Is not capable of dispensing own
medication. 0 0
H. Ability to Handle Finances.
1. Manages financial matters,
independently budgets, writes checks,
pays rent, bills, goes to bank, collects and
keeps track of income. 1 1
2. Manages day-to-day purchases, but needs
Help with banking, major purchases etc. 1 1
3. Incapable of handling money. 0 0
Return to Weekly Schedule/Assignments.
Return to Nursing 211 Homepage.