Functional health assessment


Published on

  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Functional health assessment

  1. 1. Functional Health Pattern Marjorie Gordon (1987) proposed functional health patterns as a guide for establishing a comprehensive nursing data base. These 11 categories make possible a systematic and standardized approach to data collection, and enable the nurse to determine the following aspects of health and human function:
  2. 2. Health Perception and Health Management. Data collection is focused on the person's perceived level of health and well-being, and on practices for maintaining health. Habits evaluated includes smoking and alcohol or drug use. Actual or potential problems related to safety and health management may be identified as well as needs for modifications in the home or needs for continued care in the home.
  3. 3. Client’sgeneral health? Anycoldsin pastyear? If appropriate:anyabsences fromwork/school? Most importantthings youdo tokeep healthy? Use ofcigarettes,alcohol, drugs? Performself exams,i.e. Breast/testicularself- examination? Accidentsathome,work,school,driving? In past,hasitbeen easytofindwaysto carryout doctor’sor nurse’ssuggestions? (If appropriate)Whatdoyouthinkcausedcurrent illness? Whatactionshaveyoutakensincesymptomsstarted? Have youractionshelped? (If appropriate)Whatthings aremostimportantto yourhealth? How canwebemost helpful? Howoftendoyouexercise?
  4. 4. Nutrition and Metabolism Assessment is focused on the pattern of food and fluid consumption relative to metabolic need. The adequacy of local nutrient supplies is evaluated. Actual or potential problems related to fluid balance, tissue integrity, and host defenses may be identified as well as problems with the gastrointestinal system.
  5. 5. History (subjective data): Typical daily food intake? (Describe) Use of supplements, vitamins, types of snacks? Typical daily fluid intake? (Describe) Weight loss/gain? Height loss/gain? Appetite? Breastfeeding? Infant feeding? Food or eating: Discomfort, swallowing difficulties, diet restrictions, able to follow? Healing – any problems? Skin problems: lesions? Dryness? Dental problems?
  6. 6. Examination (examples of objective data): Skin assessment, oral mucous membranes, teeth, actual weight/height, temperature. Abdominal assessment.
  7. 7. Elimination. Data collection is focused on excretory patterns (bowel, bladder, skin). Excretory problems such as incontinence, constipation, diarrhea, and urinary retention may be identified.
  8. 8. History (subjective data): Bowel elimination pattern (describe) Frequency, character, discomfort, problem with bowel control, use of laxatives (i.e. type, frequency), etc.? Urinary elimination pattern (describe) Frequency, problem with bladder control? Excess perspiration? Odour problems? Body cavity drainage, suction, etc.?
  9. 9. Examination (examples ofobjective data): If indicated, examineexcretions or drainage for characteristics, colour, and consistency. Abdominal assessment.
  10. 10. Activity and Exercise. Assessment is focused on the activities of daily living requiring energy expenditure, including self- care activities, exercise, and leisure activities. The status of major body systems involved with activity and exercise is evaluated, including the respiratory, cardiovascular, and musculoskeletal systems.
  11. 11. History (subjective data): Sufficient energyfor desired and/or required activities? Exercise pattern? Type? regularity? Sparetime (leisure) activities? Child-play activities? Perceivedability for feeding, grooming, bathing, general mobility, toileting, home maintenance, bed mobility, dressing and shopping?
  12. 12. Examination (examples ofobjective data): Demonstrate ability for above criteria. Gait. Posture. Absent body part. Range of motion (ROM) joints. Hand grip - can pick up pencil? Respiration. Blood pressure. General appearance. Musculoskeletal, cardiacand respiratory assessments.
  13. 13. Cognition and Perception. Assessment is focused on the ability to comprehend and use information and on the sensory functions. Data pertaining to neurologic functions are collected to aid this process. Sensory experiences such as pain and altered sensory input may be identified and further evaluated.
  14. 14. History(subjective data): Hearing difficulty? Hearing aid? Vision? Wears glasses? Last checked?When last changed? Anychangein memory?Concentration? Importantdecisions easy/difficult to make? Easiest way for youto learn things? Anydifficulty? Anydiscomfort? Pain? Ifappropriate – PQRST questions PQRST P – Palliative, Provocative Q - Quality or quantityR – Regionor radiation S - Severity or scale T -Timing(Morton, 1977) COLDSPA C-CharacterO -Onset L -Location D - Duration S – SeverityP -Pattern A -Associated factors (Weber, 2003)
  15. 15. Examination (examples of objective data): Orientation. Hears whispers? Reads newsprint? Grasps ideas and questions (abstract, concrete)? Language spoken. Vocabulary level. Attention span.
  16. 16. Sleep and Rest. Assessment is focused on the person's sleep, rest, and relaxation practices. Dysfunctional sleep patterns, fatigue, and responses to sleep deprivation may be identified.
  17. 17. History (subjective data): Generally rested and ready for activity after sleep? Sleep onset problems? Aids? Dreams (nightmares), early awakening? Rest / relaxationperiods? Sleep routine? Sleep apnea symptoms?
  18. 18. Examination (examplesof objectivedata): Observe sleep pattern and rest pattern.
  19. 19. Self-Perception and Self- Concept. Assessment is focused on the person's attitudes toward self, including identity, body image, and sense of self-worth. The person's level of self-esteem and response to threats to his or her self-concept may be identified.
  20. 20. History (subjective data): Howdo youdescribe yourself? Most of the time, feel good (ornot so good) about self? Changes in body or things you can do? Problems for you? Changes in the way you feel about self orbody (generally orsince illness started)? Things frequently make you angry? Annoyed? Fearful? Anxious? Depressed? Not able to control things? What helps? Everfeel you lose hope?
  21. 21. Examination (examples of objective data): Eye contact. Attention span (distraction?). Voice and speech pattern. Body posture. Client nervous (5) or relaxed (1) (rate scale1-5) Client assertive (5) or passive (1) (rate scale1-5)
  22. 22. Roles and Relationships. Assessment is focused on the person's roles in the world and relationships with others. Satisfaction with roles, role strain, or dysfunctional relationships may be further evaluated.
  23. 23. History (subjective data): Livealone?Family? Family structure? Anyfamilyproblemsyouhavedifficultyhandling (nuclear/extendedfamily)? Family orothersdependon youforthings? How well areyoumanaging? If appropriate–How families/othersfeel about yourillness? Problemswith children? Belong tosocial groups?Closefriends? Feel lonely? (Frequency) Things generally gowellatwork/ school? If appropriate–income sufficientforneeds? Feel partof(orisolatedin) yourneighbourhood?
  24. 24. Examination (examplesof objectivedata): Interactionwithfamily members or others if present.
  25. 25. Sexuality and Reproduction. Assessment is focused on the person's satisfaction or dissatisfaction with sexuality patterns and reproductive functions. Concerns with sexuality may he identified.
  26. 26. History (subjective data): If appropriate to age and situation – Sexual relationships satisfying? Changes? Problems? If appropriate –Use of contraceptives? Problems? Female–when did menstruation begin? Last menstrual period (LMP)? Any menstrual problems? (Gravida/Para if appropriate)
  27. 27. Examination (examples of objective data): None unless a problem is identified or a pelvic examinationis warranted aspart of full physicalassessment (advanced nursing skill).
  28. 28. Coping and Stress Tolerance. Assessment is focused on the person's perception of stress and on his or her coping strategies Support systems are evaluated, and symptoms of stress are noted. The effectiveness of a person's coping strategies in terms of stress tolerance may be further evaluated.
  29. 29. History (subjective data): Any big changes in your life in last year or two? Crisis? Who is most helpful in talking things over?Available to you now? Tense orrelaxed most of the time? When tense, what helps? Useany medications, drugs, alcohol to relax? When (if)there are big problems in your life, howdo you handle them? Most of the time, are these ways successful?
  30. 30. Values and Belief. Assessment is focused on the person's values and beliefs (including spiritual beliefs), or on the goals that guide his or her choices or decisions.
  31. 31. History (subjective data): Generally get things you want from life? Important plans for future? Religion important to you? If appropriate -Does this help when difficulties arise? If appropriate – willbeing here interfere with any religious practices?
  32. 32. Sample.pptx
  33. 33. APGAR SCORE The test is generally done at one and five minutes after birth, and may be repeated later if the score is and remains low. Scores 7 and above are generally normal, 4 to 6 fairly low, and 3 and below are generally regarded as critically low. Appearance (skin color), Pulse (heart rate), Grimace(reflex irritability), Activity (muscle tone), and Respiration
  35. 35. Newborn Screening RepublicAct 9288 Newborn screening (NBS) is a public health program aimed at the early identification of infants who are affected by certain genetic/metabolic/ infectious conditions. Earlyidentification and timely intervention can lead to significantreduction of morbidity, mortality, and associated disabilities in affected infants. NBS in the Philippines started in June 1996 and was integrated into the public healthdelivery system with the enactment of the Newborn Screening Actof 2004 (Republic Act 9288). From 1996 to December 2010, the program hassaved 45 283 patients. Five conditions are currently screened: Congenital Hypothyroidism, Congenital Adrenal Hyperplasia, Phenylketonuria, Galactosemia, and Glucose-6-Phosphate Dehydrogenase Deficiency.
  37. 37. Height and Length Growth is not only a result of nutrition but also a result of inherited factors. Ethnicitycan influence a child’s growth patterns, and so some countries have their own growth charts.
  38. 38. How to Measure
  39. 39. How to take measurements Typical measurements taken for children 0- 24 months include: Head circumference Length Weight
  40. 40. Measurements should be taken at regular intervals in order to observe reliable trends. Recommendations for measurement intervals include: Infants (0-12 months): every 2 months Young Children: at 15, 18, 24 and 30 months Ages 3+: every year
  41. 41. Growth Charts Module_Branded Measurement Schedule handout.pdf
  42. 42. Head Circumference Head circumference is a measurement taken around the largest part of a child’s head. This measurement is typically taken with children ages 0-3 years old. The measurement should be taken with a measuring tape that cannot be stretched. This is typically a flexible, metal measuring tape. To measure, securely wrap the tape around the widest possible circumference of the head. Typically, this is from 1-2 finger-widths above the eyebrow on the forehead to the most prominent part of the back of the head. Take the measurement three times and select the largest measurement to the nearest 0.1cm.
  43. 43. cht_hcfa_boys_z_0_2.pdf cht_hcfa_girls_z_0_2.pdf
  44. 44. Height - it is good determination of health and normal nutrition as weight -male infant is an average of 2-3cm longer than of female at birth -During first year of the life the infant HT should increase by 25-30 cm - by age 2 yrs , the child will be an average of 12.5 cm taller -most toddlers have reached approximately 12 of their adult height. -AT birth: 46-56cm , average( 50cm)
  45. 45. Length Length is the linear measurement for infants up to 24 months. Length measurements (instead of height) are also taken for children 24 to 36 months who cannot stand without assistance.
  46. 46. Length Length is measured when children are in a recumbent (lying down) position. The most accurate way to measure length is by using a calibrated length board. Length boards should have a fixed headpiece and a moveable foot piece perpendicular to the surface of the board. To measure, lay the child on the board with their head against the fixed headpiece. Make sure the child is not wearing shoes or a hairpiece. An assistant may be helpful to hold the child still and centered on the board. Straighten the child’s legs and adjust the moveable foot piece so the soles of the feet are against the foot piece. Record the length to the nearest 0.1 cm.
  47. 47. cht_lfa_boys_z_0_2.pdf cht_lfa_girls_z_0_2.pdf
  48. 48. Weight Weight is a measurement taken throughout the lifespan to help determine trends and current nutritional status.
  49. 49. Weight Infant weight can be accurately measured using one of several different pieces of equipment. If available, a pan-type pediatric scale allows a child to be weighed while lying down. These pediatric scales are either electronic or beam scales with non-detachable weights, and are accurate to the nearest 10 gram. Another option is a hanging scale. A hanging scale needs to be attached to a sturdy structure (e.g. building rafter, door frame) and the child is suspended from the scale in weighing pants.
  50. 50. Weight To measure, make sure the child is wearing as little clothing as possible and that no one is touching the child. Read the scale at eye-level and record weight to the nearest 10 gram. Repeat the measurement three times, exclude values that appear skewed, and find the average.
  51. 51. Weight
  52. 52. In the event a baby scale is unavailable, an adult standing scale can be used to measure infant weight. Weigh an adult first, and then weigh the same adult while holding a child. Find the difference between the two weights – this is the infant’s weight. Weight-for-age is an important indicator of a child’s nutritional status over time, such as trends in underweight.
  53. 53. Weight: Average newborn boy weight=3400g, and girl= 3200g - infant lose 5-10% of birth weight at age 3-4 days to gain it back in 2 weeks with a steady growth rate. infant double birth Wight by 6 month they triple the body weight by 12 month= 10 kg.
  54. 54. Chest, and abdominal circumference. Whaley and Wong
  55. 55. Abdominal Girth Abdominal girth should be measured over the umbilicus Whenever possible.
  56. 56. head circumference and chest circumference : Measure at birth and routinely until age 3 yrs. HC measures directly skeletal growth (skull), and indirectly cerebral growth. Measurement at birth = 33-35 cm Chest circumference : CC = 31-33 cm at birth Ratio of head to chest circumference: birth : HC is larger than CC2 cm 1 yrs-18 month : HC=CC 2-3 yrs HC slightly smaller than CC > 3 yrs :HC is smaller than CC by 5-7 cm
  57. 57. Metro Manila Development Screening Test (MMDST) Developed for health professionals (MDs, RNs, etc) It is not an intelligence test It is a screening instrument to determine if child’s development is within normal Children 6 ½ years and below
  58. 58. Purposes Measures developmental delays Evaluates 4 aspects of development Metro Manila Development Screening Test (MMDST)
  59. 59. 4 sectors of development Personal-Social – tasks which indicate the child’s ability to get along with people and to take care of himself Fine-Motor Adaptive – tasks which indicate the child’s ability to see and use his hands to pick up objects and to draw Language – tasks which indicate the child’s ability to hear, follow directions and to speak Gross-Motor – tasks which indicate the child’s ability to sit, walk and jump
  60. 60. MMDST KIT. Preparation for test administration involves the nurse ensuring the completeness of the test materials contained in the MMDST Kit. These materials should be followed as specified: MMDST manual test Form bright red yarn pom-pom rattle with narrow handle eight 1-inch colored wooden blocks (red, yellow, blue green) small clear glass/bottle with 5/8 inch opening small bell with 2 ½ inch-diameter mouth rubber ball 12 ½ inches in circumference cheese curls pencil
  62. 62. What is the Barthel Index? The Barthel Index consists of 10 items that measure a person's daily functioning specifically the activities of daily living and mobility. The items include feeding, moving from wheelchair to bed and return, grooming, transferring to and from a toilet, bathing, walking on level surface, going up and down stairs, dressing, continence of bowels and bladder.
  63. 63. How is the Barthel Index used? The assessment can be used to determine a baseline level of functioning and can be used to monitor improvement in activities of daily living over time. The items are weighted according to a scheme developed by the authors. The person receives a score based on whether they have received help while doing the task. The scores for each of the items are summed to create a total score. The higher the score the more "independent" the person. Independence means that the person needs no assistance at any part of the task. If a persons does about 50% independently then the "middle" score would apply.
  64. 64. KATZ INDEX WHY: Normal aging changes and health problems frequently show themselves as declines in the functional status of older adults. Decline may place the older adult on a spiral of iatrogenesis leading to further health problems. One of the best ways to evaluate the health status of older adults is through functional assessment which provides objective data that may indicate future decline or improvement in health status, allowing the nurse to plan and intervene appropriately.
  65. 65. BEST TOOL: The Katz Index of Independence in Activities of Daily Living, commonly referred to as the Katz ADL, is the most appropriate instrument to assess functional status as a measurement of the client’s ability to perform activities of daily living independently. Clinicians typically use the tool to detect problems in performing activities of daily living and to plan care accordingly. The Index ranks adequacy of performance in the six functions of bathing, dressing, toileting, transferring, continence, and feeding. Clients are scored yes/no for independence in each of the six functions. A score of 6 indicates full function, 4 indicates moderate impairment, and 2 or less indicates severe functional impairment.
  66. 66. BMI Your BMI is based on your height and weight. It's one way to see if you're at a healthy weight. Underweight: Your BMI is less than 18 Healthy weight: Your BMI is 18.5 to 24.9 Overweight: Your BMI is 25 to 29.9 Obese: Your BMI is 30 or higher
  67. 67. HOW TO CALCULATE YOUR BODY MASS INDEX OR BMI BMI is your weight (in kilograms) over your height squared (in centimeters). Let’s calculate, however, using pounds and inches. For instance, the BMI of a person who is 5’3" and weighs 125 lbs is calculated as follows:
  68. 68. 1. Multiply the weight in pounds by 0.45 (the metric conversion factor) 125 X 0.45 = 56.25 kg 2. Multiply the height in inches by 0.025 (the metric conversion factor) 63 X 0.025 = 1.575 m
  69. 69. 3. Square the answer from step 2 1.575 X 1.575 = 2.480625 4.Divide the answer from step 1 by the answer from step 3 56.25 : 2.480625 = 22.7 •1.575 X 1.575 = 2.480625
  70. 70. The BMI for a person who is 5’3" and weighs 125 lbs is 22.7 or practically, 23
  71. 71. Template Provided By 500,000 Downloadable PowerPoint Templates, Animated Clip Art, Backgrounds and Videos