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Chapter: Medical Surgical Nursing: Principles and Practices of Rehabilitation

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Assessment of Functional Abilities

Comprehensive assessment of functional capacity is the basis for developing a rehabilitation program.

Assessment of Functional Abilities

Comprehensive assessment of functional capacity is the basis for developing a rehabilitation program. Functional capacity mea-sures a person’s ability to perform activities of ADLs and IADLs. ADLs include activities performed to meet basic needs, such as personal hygiene, dressing, toileting, eating, and moving. IADLs include activities that are necessary for independent living, such as the ability to shop for and prepare meals, use the telephone, clean, manage finances, and travel.

 

The nurse observes the patient performing specific activities (eg, eating, dressing) and notes the degree of independence; the time taken; the patient’s mobility, coordination, and endurance; and the amount of assistance required. Good joint motion, mus-cle strength, cardiovascular reserve, and an intact neurologic sys-tem are also carefully assessed, because functional ability depends on these factors as well. Observations are recorded on a functional assessment tool. These tools provide a way to standardize assess-ment parameters and supply a scale or score against which im-provements may be measured. They also clearly communicate the patient’s level of functioning to all members of the rehabilitation team. Rehabilitation staff use these tools to provide an initial as-sessment of the patient’s abilities and to monitor the patient’s progress in independence.

 

One of the most frequently used tools to assess the patient’s level of independence is the Functional Independence Measure (FIM). The FIM is a minimum data set, measuring 18 items. The self-care items measured are eating, bathing, grooming, dressing upper body, dressing lower body, toileting, bladder management, and bowel management. The FIM addresses transfers and the ability to ambulate and climb stairs and also includes communi-cation and social cognition items. A WeeFIM instrument is used for children. For both children and adults, scoring is based on a seven-point scale with items used to assess the patient’s level of independence.

 

The PULSES profile is used to assess physical condition (eg, health/illness status), upper extremity functions (eg, eating, bathing), lower extremity functions (eg, transfer, ambulation), sensory function (eg, vision, hearing, speech), excretory function (ie, control of bowel or bladder), and situational factors (eg, so-cial and financial support). Each of these areas is rated on a scale from one (independent) to four (greatest dependency).

 

The Barthel Index is used to measure the patient’s level of in-dependence in ADLs (feeding, bathing, dressing, grooming), continence, toileting, transfers, and ambulation (or wheelchairmobility). This scale does not address communicative or cogni-tive abilities.

 

The Patient Evaluation Conference System (PECS) contains 15 categories. This comprehensive assessment scale includes such areas as medications, pain, nutrition, use of assistive devices, psy-chological status, vocation, and recreation. There are many other assessment tools designed to evaluate function in persons with specific disabling conditions.

 

In addition to the detailed functional assessment, the nurse as-sesses the patient’s physical, mental, emotional, spiritual, social, and economic status. Secondary problems related to the disabil-ity, such as muscle atrophy and deconditioning, are assessed, as are residual strengths unaffected by disease or disability. Other areas that require nursing assessment include potential for altered skin integrity, altered bowel and bladder control, and sexual dys-function.


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