Functional Ability

• Functional Ability

  The physical, psychological, cognitive and social ability to carry on normal activities of life
• Basic Activities of Daily Living (BADLs)

  • Eating
  • Bathing
  • Dressing
  • Grooming
  • Toileting
  • Mobility
• Instrumental Activities of Daily Living (IADLs)

  • Managing Finances
  • Meal Preparation and Planning
  • Transportation
  • Medication Management
  • Household Management
• Physical Function

  Assesses a person's ability to perform physical tasks and activities of daily living [ADLs]
• Cognitive Function

  Refers to a person's mental abilities, including memory, reasoning, problem-solving, and decision-making
• Emotional and Social Function

  Focuses on a person's emotional well-being and their ability to engage in social interactions
• Instrumental Activities of Daily Living (IADLs)

  More complex daily tasks that require a higher level of cognitive and physical functioning
• The client's level of self care and their functional abilities are an integral part of a complete assessment
• How to recognize a problem or decline in Functional Ability

  • Self-report –patient's or family perception of functional ability
  • Performance based – provide actual observation of a standardized task, judged by objective criteria
• Potential causes/risk factors of functional decline

  • Aging
  • Chronic Diseases
  • Neurological Disorders
  • Injuries
  • Frailty
  • Mental Health Disorders
  • Medications
  • Obesity
  • Sensory Impairments
  • Lifestyle Factors
• A comprehensive assessment is necessary to determine underlying factors contributing to a patient's decline in functional ability
• Addressing these causes often involves a multidisciplinary approach
• Types of Functional Impairment


  • Medically induced impairment like a Stroke
  • Sensory induced impairment like Hearing Loss
  • Psychologically induced impairment like Anxiety
  • Cognitively impaired like in Dementia
• Some Functional Assessment Tools

  • MINI MENTAL STATUS EXAMINATION
  • PHQ-9 DEPRESSION SCALE
  • FUNCTIONAL ACTIVITES QUESTIONNAIRE
  • KATZ INDEX OF INDEPENDENCE IN 6 BADL
  • BARTHEL INDEX (measure continence, toileting, transfer, ambulation)
  • NGAGED
  • Unified Parkinson's Disease Rating Scale (UPDRS)
  • Functional Independence Measure (18 BADLS)
• Nursing Care; Focus on Prevention

  • Primary Prevention: Education, Risk recognition
  • Secondary Prevention: Screening, Early detection and prompt Intervention
  • Tertiary Prevention: Goal is to return to pre-injury, pre-illness level of function, Preventing other comorbidities
• Nursing Care; Focus on Intervention

  • Regular participation in meaningful activity
  • Fall prevention measures
  • Avoidance of tobacco and other substances associated with abuse
• Parkinson's Disease

  Slowly progressing neurological movement disorder that eventually leads to disability
• Alzheimer's

  Most common form of dementia; A progressive, degenerative loss of cognitive function resulting from neuron damage or death
• Cerebral Vascular Accident (CVA, Stroke)

  • Interruption of blood supply to the brain
  • If suspected in any environment, call 911 Immediately or call a CODE
  • Brain cells begin to die in minutes especially without supplemental Oxygen
• Dysphagia is common after stroke
• Keep the patient on NPO status until a speech therapist does a swallowing evaluation
• Downs Syndrome

  Chromosomal genetic disorder that includes a combination of birth defects resulting in cognitive and sensory impairment
• Alzheimer's PHARM

  Donepezil (increase nerve impulse by preventing ACh breakdown), memantine (reduce client disorientation by blocking nerve cell damage), cholinesterase (inhibitors) pimavanzserin (antipsychotic), estrogen therapy for female, ginkgo biloba intake to increase memory and circulation

  Education: seizures in later stage, coping strategies, and home safety
• Alzheimers Diseases: neurons involved with communication, metabolism and repair are disrupted

  RF: chemical imbalances, hx of AD and Down syndrome, environment, f sex, PTSD

  S&S: mild (memory lapse, losing items, no focus), moderate (forgets ones history, difficulty with math, behavior change), severe (loss of conversation, ADLs assisted, incontinence)

  Diagnostics: brain tissue examination upon death

  Labs: CBC, vit B12, TH levels, CSF examination

  Interventions: assess cognitive status, memory judgement, judgement, personality changes, provide cognitive stimulation
• Down Syndrome: chromosome 23 has 3 copies

  RF: maternal age 35+, family hx

  S&S: flat face, eyes slant up, unusual ears, 1 palm crease, gap toe

  Diagnostics: denver developmental screening test, a-fetoprotein lab

  Interventions: independency, fall precaution, reorient

  TX: TH replacement and meds for complications

  Education: special ed & occupational program
• Parkinson's disease: progressively debilitating disease that grossly affects motor function due to over stimulation of basal ganglia by ACh

  RF: age 50+, m sex, genetics, environment toxins, chronic use of antipsychotics

  S&S: bradykinesia, akinesia, stoop posture, slow shuffle gait, slow speech, tremors, muscle rigidity, mask like expression, dysphasia, diaphoresis

  Interventions: monitor swallowing, maintain mobility, monitor mental

  Therapeutic measure: deep brain stimulation
• Parkinsons Disease PHARM

  • Caribidopa-levodopa (dopaminergenic agent that increase dopamine), used with ropinirole (requip) (dopamine agonists that activate release of dopamine), and benztropine (anticholinergic to control tremors/rigidity)
• Cerebrovascular Accident (stroke): A sudden loss of brain function due to a blockage in the blood supply to the brain (ischemic)

  RF: cerebral aneurysm, hx, age, diabetes, HTN, hyperlipidemia, smoking

  S&S: severe headache, vertigo, gait/vision impair, confusion, aphasia

  Diagnostics: CBC, coagulation panel, dopper US, angiography

  Interventions: ICP monitor, liquid consistency level, feed assist

  Therapeutic measure: thrombectomy, carotid artery angioplasty with stent

  Education: sit up right to eat, dressing, "FAST" facial droop, arm weakness, speech impair, time to call 911
• Cerebrovascular Accident (stroke) PHARM

  • Thrombolytics, anticoagulants, antiplatlets, antihypertensives