Functional Ability Study Notes

FUNCTIONAL ABILITY

Introduction

Kristin Pilong, DNP, RN, CNL presents the topic of functional ability within nursing and healthcare contexts.

LESSON OUTCOMES

Discuss personal and environmental factors that create a potential for injury.
Describe strategies that can assist in reducing the risk of client injury.
Assess client’s functional ability and plan care accordingly.
Understand nursing care related to Parkinson’s Disease.

CONCEPT: FUNCTIONAL ABILITY

Definition: Functional ability is the individual’s capacity to perform normal daily activities to meet basic needs. It encompasses:
- Fulfillment of usual roles in family, workplace, and community.
- Maintenance of health and well-being.
Reflects the adaptive dimension of development, including the acquisition of skills that promote independence in home and community settings.
Incorporates cognitive, social, physical, and emotional abilities necessary for daily life activities.

SCOPE

Disability: Refers to negative aspects of a person’s health condition and limitations in social or physical capacities.
Impairment: Denotes physical abnormalities caused by disease processes that lead to limitations.
Function: Indicates positive or neutral interactions between an individual’s health condition and their ability to perform social or physical activities.

LIFESPAN CONSIDERATIONS

Functional ability changes across a lifespan influenced by:
  - Developmental stage.
  - Achievement of developmental milestones.
  - Physical health status.
  - Psychosocial health.
  - Cognitive ability.
  - Social and cultural factors.

ACTIVITIES OF DAILY LIVING (ADLs)

Definition: Essential elements of self-care; inability to independently perform any may indicate a need for supportive services.
Basic Activities of Daily Living (BADLs): Fundamental tasks associated with independent living in the community.
Instrumental Activities of Daily Living (IADLs): More complex activities necessary for living independently.

ESSENTIAL ADLs

Activities that measure self-care include:
  - Eating.
  - Bathing.
  - Grooming (washing, combing hair, shaving, cleaning teeth, dressing).
  - Toileting.
  - Walking (including propelling a wheelchair and using stairs).
  - Transferring (e.g., from bed to chair).
ADL instruments can be self-reported, task observed, or reported by a proxy/surrogate.

ASSESSMENT TOOLS FOR ADLs

Katz Index of Independence in Activities of Daily Living:
  - Purpose: Measures the ability to perform basic ADLs independently.
  - Activities Assessed: Bathing, dressing, toileting, transferring, continence, feeding.
  - Scoring: Activities are scored 'independent' or 'dependent.' Total score ranges from 0 (completely dependent) to 6 (completely independent).
  - Usage: Commonly employed in clinical settings for elderly patients.
Barthel Index:
  - Purpose: Evaluates ability to perform ADLs and degree of assistance required.
  - Activities Assessed: Includes feeding, bathing, grooming, dressing, bowel and bladder control, toilet use, transfers, mobility, and stairs.
  - Scoring: Each activity scored based on level of assistance; total score ranges from 0 (completely dependent) to 100 (completely independent).
  - Usage: Widely used in rehabilitation settings to monitor progress.

COMPARISON OF ASSESSMENT TOOLS

Katz Index:
- Simple and quick to administer.
- Focuses solely on basic ADLs.
Barthel Index:
- More comprehensive; includes both basic and instrumental ADLs.
- Provides finer gradation of dependency levels.

INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADLs)

Goal: Assess functional abilities necessary for independent living in the community.
Activities Assessed: Include shopping, meal preparation, housekeeping, laundry, managing finances, taking medications, and using transportation.
Bias: Instruments may reflect cultural or gender biases, particularly in older cohorts. Tasks measured are historically those done by women, often neglecting tasks primarily done by men (e.g., home repairs).

LAWTON INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL)

Purpose: Assesses ability to perform tasks allowing independent community living.
Activities Assessed: Using a telephone, shopping, food preparation, housekeeping, laundry, transportation, medication management, and handling finances.
Scoring: Rated based on independence from 0 (low function, dependent) to 8 (high function, independent).
Usage: Primarily for older adults to determine independent living ability and identify assistance needs.

RISK RECOGNITION

Good functional abilities correlate with positive health outcomes, while deficits correlate with poor outcomes.
Early identification of functional affecting factors is essential, including:
  - Developmental abnormalities.
  - Trauma (physical/psychological).
  - Diseases (acute or chronic).
  - Social and cultural influences.
  - Age.
  - Cognitive and mental health issues (especially depression).
  - Comorbid conditions.
  - Socioeconomic factors.
Preclinical Disability: Clients may modify tasks to compensate for deficits.
Acute Functional Decline: Sudden drops in ability often indicate an acute illness or worsening chronic disease.

MOTOR SKILLS AND THEIR IMPLICATIONS

Gross Motor Skills (utilizing large muscles): include activities like:
- Sitting, standing, walking, running, jumping, lifting, kicking.
Fine Motor Skills (utilizing small muscles): include:
- Holding a pencil, writing, cutting, threading beads, and using utensils for self-feeding.

FUNCTIONAL ASSESSMENT APPROACHES

Self-Reporting Tools:
- Advantages: Quick data collection.
- Disadvantages: Patient perceptions may not align with reality; varying interpretations of questions.
Performance-based Tools:
- Advantages: Observe actual performance, can ensure accurate measurement.
- Disadvantages: May take longer to complete.

REDUCING RISK FOR CLIENTS

Educate patients and families on maintaining high functional abilities through:
  - Well-balanced nutrition.
  - Regular physical activity.
  - Routine health checkups.
  - Stress management strategies.
  - Engagement in meaningful activities.
  - Fall prevention measures.
  - Avoidance of substance misuse (tobacco etc.).

NURSING INTERVENTIONS FOR FUNCTIONAL IMPAIRMENT

Assist with self-care needs including ADLs and IADLs, which include:
- Dressing, toileting, bathing, ambulating, shopping, cooking, and eating.
Address communication, mobility, and psychosocial support needs.
Encourage participation in exercise therapy and teaching safe use of assistive devices.

PARKINSON'S DISEASE

Description: A chronic degenerative disorder affecting neurons in the basal ganglia with specific brain regions impacted:
  - Thalamus.
  - Caudate.
  - Putamen.
  - Globus Pallidum.
  - Subthalamic Nucleus.
  - Substantia Nigra.
  - Cerebellum.
  - Amygdala.
  - Striatum.

5 STAGES OF PARKINSON’S DISEASE

Stage I: Unilateral shaking or tremor of one limb.
Stage II: Bilateral limb involvement, difficulty in balance, mask-like face.
Stage III: Significant slowing of movement, postural instability, more challenging walking.
Stage IV: Tremors may decrease, but akinesia and rigidity impede daily tasks; possible increase in care dependency.
Stage V: Total dependency for care, inability to stand or walk, possible dementia.

FREEZING EPISODES

Definition: A temporary, involuntary inability to move. During freezing episodes, a person may feel as if their feet are glued to the ground.
Common Situations: Transitioning from standing to walking, entering a doorway, or turning corners.
"Off" Freezing: Occurs when the person is due for their next dose of dopaminergic medications. Symptoms lessen after taking medication.

LEVODOPA/CARBIDOPA

Function: Dopamine synthesis medication (levodopa) combined with a dopamine agonist (carbidopa).
Effectiveness: Most effective for treating Parkinson’s Disease but loses efficacy by the end of year 5.
Effects: ”Wearing off” and “On-off” phenomena can indicate medication level fluctuations.

ADVERSE EFFECTS OF LEVODOPA/CARBIDOPA

Common effects include nausea, vomiting, and drowsiness.
Nursing Actions: Administer with food; small doses to manage GI side effects, avoid high-protein foods that delay absorption and efficacy.
Client Education: Suggest eating protein in small portions throughout the day and avoid foods with pyridoxine content (wheat germ, bananas, legumes) that may diminish therapeutic effect.

NURSING MANAGEMENT - ASSESSMENTS

Monitor for:
  - Tremors, rigidity, and bradykinesia.
  - Swallowing difficulties, excess drooling (risk for aspiration).
  - Mobility challenges due to ataxia, bradykinesia, and instability.
  - Bowel and bladder function issues (risk for incontinence and constipation).

NURSING MANAGEMENT - ACTIONS

Implement strategies including:
  - Administering stool softeners and encouraging fluid intake.
  - Promoting self-care participation.
  - Facilitating collaboration between disciplines like physical therapy, occupational therapy, and speech therapy.
  - Providing communication support and psychosocial assistance.

INTERRELATED CONCEPTS

Family Dynamics
Cognition
Development
Stress and Coping
Functional Ability
Perfusion
Culture
Sexuality
Elimination
Nutrition
Sensory Perception
Mobility
Gas Exchange