8 SELFCARE Flashcards
GOALS IN SELF-CARE (3)
Preventing loss of independence.
Maintaining ability to perform tasks.
Improve ability to manage tasks independently.
DEVELOPMENTAL INFLUENCE
Activities of self-care are basic to human development.
AREAS OF SELF-CARE
Every day activities.
Usually done: with little thought, without assistance.
ADL
Activities of Daily Living.
BADL
Basic Activities of Daily Living.
ADL VS IADL
ADL: Activities of Daily Living, grooming, dressing, bathing.
IADL: Instrumental Activities of Daily Living, housekeeping, money management, meal prep, shopping.
FUNCTIONAL MOBILITY
Moving from one position or place to another.
Bed mobility.
Wheelchair mobility.
Transfers.
Ambulation.
Transporting objects.
TRANSFER TO HOUSEHOLD FUNITURE
Couches, easy/kitchen chairs, beds, recliners.
WHY TRANSFER TO OTHER FURNITURE
Break from wheelchair.
Join family / other social groups.
A more “normal” way of being in the environment and/or interacting in social situations.
CHANGES TO THE METHOD OF TRANSFER TO FURNITURE
Be aware of environmental differences .
Take precautions.
Know yourself.
Know your client.
By yourself.
Clients at home.
Client cannot give more help.
Moving around an armrest.
CHANGES TO THE ENVIRONMENT FOR TRANSFER TO FURNITURE
Raise chairs/beds.
Preferred height.
Extra cushions/firm cushions.
Plywood base under cushion/mattress.
Grab bars.
Vertical ceiling to floor pole: Superpole
PRECAUTIONS FOR TRANSFER TO FURNITURE
Equipment: securely positioned or fastened.
Clients physical/cognitive status: impulsive/unpredictable, weak.
Practice may lead to injury/falls: task is new, client refuses devices, may forget to use equipment, may be impulsive.
Proper footwear and body mechanics.
TOILET TRANSFERS: CHALLENGES
Confined space.
Small surface area on the toilet seat.
Toilet seat gets slippery.
No trunk support.
Low seat height: 14”-20” from floor.
POTENTIAL PROBLEMS WITH TOILET TRANSFERS
Wheelchair to toilet angle.
Client may need to face the toilet.
Hemiplegia.
Cannot always move towards their strong side.
Helper position.
Toilet seat unstable.
CHANGES TO METHOD IN TOILET TRANSFER
For independent standing pivot from w/c:
Client faces handrail.
Approaches toilet at 90 degrees.
Brakes on, footrest off or removed.
Move to edge of chair.
Grasp handrail, stand.
Pivot and sit.
CHANGES TO THE ENVIRONMENT WITH TOILET TRANSFERS
Grab bars.
Toilet arm rests.
Raised toilet seats. (RTS)
Commode chair.
TUB TRANSFER: CHALLENGES
Wheelchair, tub angle.
Hemiplegia.
Small space.
Client is reaching for something.
Tub height and style.
CHANGES TO METHOD OF TUB TRANSFERS
Dry tub.
Transfer in/out of a dry tub.
Hemiplegia.
Same w/c and bath seat height.
Managing legs: either one at a time, or swinging the legs in.
BATHTUB TRANSFER CHALLENGES
Wheelchair - tub angle
Hemiplegia
One way - will not be able to move towards their strong side
Helper position. Small space
Client may have reach for side of the tub: client may reach for shower curtain railing, NOT SAFE.
Tub height & style.
CHANGES TO METHOD OF BATHTUB TRANSFERS
Last step in transfer training.
Actual bathing.
Hemiplegia.
CHANGES TO THE ENVIRONMENT FOR TUB TRANSFER
Grab bars.
Bath seats/tub transfer bench.
Bathmats/adhesive strips.
Hand-held shower heads.
Bath lift.
CHANGES TO ENVIRONMENT FOR BATHTUB TRANSFERS
Grab bars.
Bath seats.
Bathmats.
Hand held shower heads.
PRECAUTIONS TO TUB TRANSFERS
Ensure client safety.
Do not leave client unattended.
Observe for potential skin problems.
Watch for confusion, fatigue, daily fluctuations in functioning, fall risk.
Clients will use inappropriate hardware.
Increased time required.
PRECAUTIONS TO BATHTUB TRANSFERS
VEHICLE TRANSFERS: CHALLENGES
Limited helper space.
Large space between w/c and vehicle seat.
Hemiplegia.
CHANGES TO METHOD IN VEHICLE TRANSFERS
2 door: front seat.
4 door: front door opening more.
CHANGES TO THE ENVIRONMENT FOR VEHICLE TRANSFERS
Use of sliding board.
Installing hooks/bars to grab.
Wheelchair lifts.
PRECAUTIONS TO VEHICLE TRANSFERS
Ensure client safety.
Do not leave client unattended.
Watch for confusion, fall risk.
Monitor grabbing unsafe car parts.
May take longer.
Body mechanics.
GROOMING CHALLENGES: PHYSICAL
Limited sensory awareness: can’t judge water temp, where limb is.
Perceptual problems: do not recognize function of grooming items.
Limited strength/endurance, ROM, muscle tone: unable to grasp, reach body parts.
Limited postural control: affects stability.
Impaired gross/fine motor.
Impaired oral-motor control.
GROOMING CHALLENGES: COGNITIVE
No initiation or interest
Unaware of the negative effects
Miss aspects of grooming
Miss steps, not in sequence
Impaired judgment, impaired sequencing
Recognize problems - unable to solve .
GROOMING CHALLENGES: AFFECTIVE
Giving total assist.
Giving verbal commands.
No interests.
PRECAUTIONS TO GROOMING
Monitor for discomfort
Monitor balance - bending or standing.
Restrict access to harmful objects
Do not leave unattended, or monitor closely!
Watch for impulsive / unpredictable actions
Give lots of time
DRESSING
Obtaining clothing.
Dressing and undressing sequencing.
Fastening/adjusting clothing.
GUIDELINE FOR INTERVENTION
Start instruction early.
Be consistent: do task same way each time.
Undressing is learned before dressing.
Give sufficient time.
Reinforce: effort / acquiring each skill.
Minimize distractions.
GUIDELINES TO SELECTING CLOTHING
Begin with oversized clothing.
Capes/smocks.
Wear mittens when putting on sleeves.
Mark clothing.
Sew pull loop.
Socks: rub on/off, sew pull loops.
Shoes: loafers, laces, shoe horn.
Velcro.
Buttons bigger.
Zippers, adding string.
Fabrics.
DRESSING: COGNITIVE CHALLENGES
Client does not select the right clothing.
Client assists with extremities only.
Paces: slower or quicker.
Impaired error recognition, may not ask for help.
Unable for weather or socially.
PRECAUTIONS TO DRESSING
Skin integrity.
Ensure stability.
Poor standing balance.
Avoid loose shoes or slippers.
Garments selection.
Garment condition.
Client compliance.
Allow time.
FEEDING AND EATING
Setting up food
Selecting and using appropriate utensils and tableware
Bringing food or drink to mouth
Sucking, masticating, coughing and swallowing
Management of alternative methods of nourishment
3 PHASES OF SWALLOWING
Oral phase: voluntary, conscious, taste/smell, texture, “Bolus” prepared and propelled towards back of tongue.
Pharyngeal phase: involuntary reflexive, moves bolus into esophagus, “point of no return”.
Esophageal phase: involuntary reflexive, moves bolus into stomach.
DYSPHAGIA
Difficulty with eating and swallowing.
FEEDING/EATING CHALLENGES: PHYSICAL
Lack of sensory awareness.
Perceptual problems.
Impaired postural control.
Problems with ROM, endurance, strength.
Impaired gross/fine motor control.
Problem with oral motor control.
FEEDING/EATING CHALLENGES: AFFECTIVE
No interest.
Demonstrates unacceptable table manners.
Does not follow a balanced diet.
Aversion to foods.
PRECAUTIONS TO FEEDING/EATING
Watch for choking vs gagging.
Ensure professional staff are close if person requires suctioning
Precut foods for client
Avoid stringy foods
Check food temperature
Watch for spills / safety
Monitor client: potential to overeat if free food access
Client may not eat if food not visible / accessible
Assist with hot liquids
Monitor compliance with diet restrictions
SEXUALITY/SEXUAL EXPRESSION
An Activity of Daily Living (self-care):
Aging
Decline in activity due to circumstance
Women: menopause
Men: changes
DEALING WITH PHYSICAL SYMPTOMS TO SEXUALITY
Activity analysis
Endurance
Loss of mobility and contractures
Joint degeneration
Pain
Loss of sensation
[Cognitive and perceptual impairments]
Inadequate vaginal lubrication
Erectile dysfunction
SEXUALITY CONCERNS
Incontinence
Medications
Isolation
Contraception
Adaptive devices
Pregnancy, delivery, child-care
