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Careplan

Self-Care Deficit, Adult

Oct.01.2020

Self-Care Deficit (Adult Inpatient)

Clinical Description

  • Care of the hospitalized patient experiencing limitations in the safe and independent performance of activities of daily living.

Key Information

  • It is important to consider the patient’s cultural norms, along with individual priorities and preferences when promoting self-care performance.
  • Early rehabilitation and care aimed at increasing self-care abilities are important to help prevent loss of independence and associated negative health outcomes.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Improved Ability to Complete Activities of Daily Living

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Overview
  • Education: Self Management
  • Education: When to Seek Medical Attention

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • health literacy
    • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Self-Care Deficit

Signs/Symptoms/Presentation

  • active movement limitation
  • bathing ability limited
  • dressing ability limited
  • grooming ability limited
  • inability to complete BADLs (basic activities of daily living)
  • inability to complete IADLs (instrumental activities of daily living)
  • laundry performance ability limited
  • limited endurance
  • meal preparation ability limited
  • medication management ability limited
  • muscle weakness
  • pain limits activity
  • personal hygiene care ability limited
  • reluctance to perform self-care
  • requires prompting to perform self-care
  • requires assistance with self-care
  • self-feeding ability limited
  • shortness of breath
  • toileting ability limited

Problem Intervention

Promote Activity and Functional Independence

  • Evaluate ability to perform and complete BADLs (basic activities of daily living) and IADLs (instrumental activities of daily living) safely and independently.
  • Identify patient’s preferences for clothing, food and personal care items; offer and honor patient choice when possible.
  • Provide therapeutic interventions, such as modifications or adaptations to personal care tasks or routines to maximize independence and safety.
  • Encourage active participation and independence in daily activity; provide level of assistance required for safety.
  • Promote use of recommended adaptive equipment, devices and orthoses.
  • Implement appropriate environmental modifications, such as decluttering and rearranging room to allow wheelchair access.
  • Maintain patient’s preferred routines and habits; respect privacy and personal space.
  • Schedule self-care activities when pain and fatigue are at a minimum to encourage optimal performance.
  • Pace activity; allow adequate time and rest periods to conserve energy.
  • Provide frequent encouragement, along with prompting and assistance as needed.
  • Provide set-up of items if patient is unable to retrieve; store personal care items in accessible location.
  • Individualize instructions and prompts to patient’s cognitive status to promote effective communication; simplify verbal directions, give encouragement and provide demonstrated cues as needed.
  • Position the patient for optimal performance, such as sitting in a chair for meals or performing hygiene at sink.

Associated Documentation

  • Activity Assistance Provided
  • Adaptive Equipment Use
  • Cognitive Support Measures
  • Self-Care Promotion

Education

CPG-Specific Education Topics

Overview

  • risk factors

  • signs/symptoms

Self Management

  • self-care

When to Seek Medical Attention

  • unresolved/worsening symptoms

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

References

  • (2018). Butcher, H. K.; Bulecheck, G. M.; Dochterman, J. M.; Wagner, C. M. (Eds.), Nursing interventions classifications (NIC). St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Chan, E. Y.; Samsudin, S. A.; Lim, Y. J. Older patients’ perception of engagement in functional self-care during hospitalization: A qualitative study. Geriatric Nursing. 2019;, 1-8. doi:10.1016/j.gerinurse.2019.11.009 Source[Expert/Committee Opinion]
  • Edemekong, P. F.; Bomgaars, D. L.; Levy, S. B.. (2020). Activities of daily living. Treasure Island, FL: StatPearls. doi:10.1016/j.apnr.2019.151189 Source[Expert/Committee Opinion]
  • Fan, B. J.; Wong, R. Y. Effect of cognitive training on daily function in older people without major neurocognitive disorder: A systematic review. Geriatrics. 2019;4(3), 44. doi: 10.3390/geriatrics4030044 Source[Systematic Review]
  • Freedman, V. A.; Kasper, J. D.; Spillman, B. C. Successful aging through successful accommodation with assistive devices. The Journals of Gerontology: Series B. 2017;72(2), 300-309. doi:10.1093/geronb/gbw102 Source[Review Articles]
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  • Hopkins, R. O.; Suchyta, M. R.; Kamdar, B. B.; Darowski, E.; Jackson, J. C.; Needham, D. M. Instrumental activities of daily living after critical illness: A systematic review. Annals of the American Thoracic Society. 2017;14(8), 1332-1343. doi:10.1513/AnnalsATS.201701-059SR [Systematic Review]
  • Lim, Y. M.; Kim, H.; Cha, Y. J. Effects of environmental modification on activities of daily living, social participation and quality of life in the older adults: A meta-analysis of randomized controlled trials. Disability and Rehabilitation: Assistive Technology. 2020;15(2), 132-140. doi:10.1080/17483107.2018.1533595 [Meta-analysis]
  • Martínez-Velilla, N.; Cadore, E. L.; Casas-Herrero, Á.; Idoate-Saralegui, F.; Izquierdo, M. Physical activity and early rehabilitation in hospitalized elderly medical patients:  Systematic review of randomized clinical trials. Journal of Nutrition, Health and Aging. 2016;20(7), 738-751. doi:10.1007/s12603-016-0683-4 [Metasynthesis,Meta-analysis,Systematic Review]
  • Pendleton, H. M.; Schultz-Krohn, W. (2018). Pedretti's occupational therapy: Practice skills for physical dysfunction. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Registered Nurses' Association of Ontario. (2015). Person- and family-centred care. Source[Quality Measures,Clinical Practice Guidelines]
  • Roberts, C. E.; Phillips, L. H.; Cooper, C. L.; Gray, S.; Allan, J. L. Effect of different types of physical activity on activities of daily living in older adults: Systematic review and meta-analysis. Journal of Aging and Physical Activity. 2017;25(4), 653-670. doi:10.1123/japa.2016-0201 Source[Meta-analysis,Systematic Review]
  • Swearingen, P. L.; Wright, J. (2019). All-in-One Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. Philadelphia: Elsevier Health Sciences. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Vining Radomski, M.; Trombly Latham, C. A. (2014). Occupational therapy for physical dysfunction. Baltimore: Wolters Kluwer/Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Wang, D. X.; Yao, J.; Zirek, Y.; Reijnierse, E. M.; Maier, A. B. Muscle mass, strength, and physical performance predicting activities of daily living: A meta‐analysis. Journal of Cachexia, Sarcopenia and Muscle. 2019;11(1), 3-25. doi:10.1002/jcsm.12502 Source[Meta-analysis]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.

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