LAWTON SCALE FOR INSTRUMENTAL ACTIVITIES OF DAILY LIVING

The Lawton scale evaluates more sophisticated functions than the Katz index. Patients or caregivers can complete the form in a few minutes. The first answer in each case—except for 8a—indicates independence, the second indicates capability with assistance, and the third indicates dependence. In this version, the maximum score is 29, although scores have meaning only for an individual patient, as when declining scores over time reveal deterioration. Questions 4 to 7 tend to be gender-specific; modify them as necessary.

1. Can you use the telephone?   without help â‘¢ with some help 2 completely unable 1 2. Can you get to places beyond walking distance?   without help â‘¢ with some help 2 not without special arrangements 1 3. Can you go shopping for groceries?   without help â‘¢ with some help 2 completely unable 1 4. Can you prepare your own meals?   without help â‘¢ with some help 2 completely unable 1 5. Can you do your own housework?   without help 3 with some help â‘¡ completely unable 1 6. Can you do your own handyman work?   without help 3 with some help â‘¡ completely unable 1 7. Can you do your own laundry?   without help â‘¢ with some help 2 completely unable 1 8a. Do you take medicines or use any medications?   Yes (If yes, answer Question 8b.)‘ â‘  No (If no, answer Question 8c.) 2 8b. Do you take your own medicine?   without help (in the right doses at the right times) â‘¢ with some help (if someone prepares it for you and/or reminds you to take it) 2 completely unable 1 8c. If you had to take medicine, could you do it?   without help (in the right doses at the right time) â‘¢ with some help (if someone prepared it for you and reminded you to take it) 2 completely unable 1 9. Can you manage your own money?   without help â‘¢ with some help 2 completely unable 1 Adapted with permission

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Tools for Assessment of Geriatric Care

Numerous tools are available to help you perform a methodical functional assessment. Some widely used methods are discussed here.

A functional assessment is used to evaluate the older adult's overall well-being and self-care abilities. It will help you identify individual needs and care deficits, provide a basis for developing a plan of care that enhances the abilities of the older adult with coexisting disease and chronic illness, and provide feedback about treatment and rehabilitation. You can use the information to identify and match the older adult's needs with such services as housekeeping, home health care, and day care to help the patient maintain independence.

 

Katz index

The Katz Index of Activities of Daily Living is a widely used tool for evaluating a person's ability to perform six daily personal care activities: bathing, dressing, toileting, transfer, continence, and feeding. It describes his functional level at a specific point in time and objectively scores his performance. (See Katz Index of Activities of Daily Living, pages 804 and 805.)

 

Lawton scale

Another widely used tool, the Lawton Scale for Instrumental Activities of Daily Living, evaluates the ability to perform more complex personal care activities. It addresses the activities needed to support independent living, such as the ability to use the telephone, cook, shop, do laundry, manage finances, take medications, and prepare meals. The activities are rated on a three-point scale, ranging from independence to needing some help to complete disability. (See Lawton Scale for Instrumental Activities of Daily Living, page 806.)

 

Barthel index and scale

The Barthel Index evaluates the following 10 self-care functions: feeding, moving from wheelchair to bed and returning, performing personal toilet, getting on and off the toilet, bathing, walking on a level surface or propelling a wheelchair, going up and down stairs, dressing and undressing, maintaining bowel continence, and controlling the bladder. Each item is scored according to the degree of assistance needed; over time, results reveal improvement or decline.

A similar scale—called the Barthel Self-Care Rating Scale—is a more detailed scale to evaluate function. Both tools provide information to help you determine the type of assistance needed.

 

OARS Social Resource Scale

The Older Americans Research and Service Center (OARS) Social Resource Scale is an assessment tool developed at Duke University in 1978. A multidimensional tool, it evaluates level of function in the following five areas:

• social resources
• economic resources
• physical health
• mental health
• activities of daily living.

The primary activities of daily living (ADLs) include mobility, dressing, personal hygiene, eating, and toileting or continence factors. However, ADLs may be expanded to include instrumental activities (shopping, household maintenance, using the telephone, paying bills, administering medications, cooking and laundry) and advanced activities (voluntary social activities, occupational activities, and recreational activities).

Each area is scored on a scale of 1 to 6. At the end of the assessment, a cumulative impairment score is determined. The lower the score, the less the degree of impairment.

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Geriatric Care

Today, people live longer than ever before. Although 40% of people over age 65 may occasionally require a stay in an extended-care facility, only 5% of elderly people require long-term supervised care; the rest can maintain their independence. However, about 80% of elderly people have at least one chronic health problem—usually arthritis, heart or respiratory disease, hypertension, or impaired vision or hearing. These problems commonly occur simultaneously, straining the patient's and his family's ability to function.

Geriatric care management is the professional assessment, planning, coordination, supervision and management of healthcare and quality-of-life services. It is a preventive, proactive approach to healthcare that reduces the risk of hospitalizations, nursing home admissions and healthcare costs. Assets can be preserved through planning, cost control and supervision of daily needs.

When caring for an elderly patient, you'll usually implement procedures similar to those you would use for any other adult. However, you'll need to take into account the psychosocial, physiologic, and biological changes that normally occur during aging. Because age-related changes in body function may affect drug action, you'll need to understand how certain drugs affect elderly patients. Your aim is to improve compliance and avoid adverse reactions and interactions.

A geriatric care manager will listen to the concerns of you and your loved one, visit the home and recommend options for improved quality of life, healthcare services and cost containment. Services include:

• Special needs assessment and management
• Creation of a full-spectrum care plan
• Referrals to professionals and specialists
• Coordination of services to maximize quality of life
• Assistance with medical and financial planning
• Daily telephone assurance service
• Healthcare bill auditing, review and payment services
• Surviving spouse programs
• Alternative living arrangement assessment and planning
• Medication management
• Nutrition and dietary management
• Pre- and post-hospitalization care coordination
• Nursing home advocacy
• Video inventory of valuables
• Environment and safety evaluations
• Coordination of in-home help
• Identification and reduction of exploitation risks
• Benefits and entitlements procurement

You'll also help an elderly patient learn to deal with other concerns, such as falls or urinary or fecal incontinence. While providing physical care, you may also alert your patient and his family to community health and social service agencies that can help improve the patient's quality of life and enable him to remain independent for as long as possible.

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Nursing Diagnoses for Planning Care

Nurses and healthcare consumers agree that nursing care is a key factor in achieving positive outcomes and enhancing client satisfaction. Nursing care is instrumental in all phases of acute care as well as in the maintenance of general wellbeing (prevention of illness, rehabilitation, and maximization of health), or where a return to health is not possible, the relief of pain and discomfort and a peaceful death. To this end, the nursing profession has identified a problem-solving process that “combines the most desirable elements of the art of nursing with the most relevant elements of systems theory, using the scientific method”.

The original concept of nursing process was a three-step process of assessment, planning, and evaluation based on the scientific method of observing, measuring, gathering data, and analyzing the findings. After years of study, use, and refinement, the three-step process was expanded. The five steps—(1) assessment, (2) problem identification, (3) planning, (4) implementation (putting the plan into action), and (5) evaluation (assessing the effectiveness of the plan and changing the plan as indicated by current needs)—are central to nursing actions and the delivery of high-quality, individualized client care in any setting.

In 1991, the ANA Standards of Clinical Nursing Practice described the client care process and standards for professional performance, providing impetus and support for the use of nursing diagnosis in the practice setting. The work of NANDA International (formerly North American Nursing Diagnosis Association) has been ongoing for more than 25 years, beginning with efforts to identify client problems/needs for which nurses are accountable. NANDA continues to develop nursing diagnostic labels, which are now being complemented by the Iowa Intervention Project: Nursing Interventions Classification (NIC) and the Iowa Outcomes Project: Nursing Outcomes Classification (NOC). NIC directs our focus to the content and process of nursing care by identifying and standardizing the care activities nurses perform while NOC describes client outcomes that are responsive to nursing intervention and developing corresponding measurement scales.

Changes in the healthcare system continue to occur, requiring the profession of nursing to define itself in a way that will complement and facilitate the provision of appropriate, cost-effective evidenced-based care to all persons. Nurses need a common framework of communication and documentation so their contribution to healthcare is recognized as being essential and they are remunerated appropriately. At the very least, nursing requires a commonality of words describing practice so it can be captured and is visible in the healthcare databases.

The linkage of nursing diagnoses to specific nursing interventions and client outcomes has led to the development of a number of standardized nursing languages (Omaha System, Clinical Care Classification, Ozbolt Patient Care Data Set, Perioperative Minimum Data Set). The purpose of these languages is to help ensure continuity of appropriate highquality nursing care for the client regardless of setting. This is accomplished in part through enhanced communication, standardization of the process evaluating the care provided, and facilitation of documentation.

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Transmission of Hepatitis C

Hepatitis C is a disease with a significant global impact. According to the World Health Organization there are 170 million people infected with hepatitis C virus (HCV). There are considerable regional differences. In Europe and the United States chronic hepatitis C is the most common chronic liver disease. The majority of liver transplants performed in these regions are for chronic HCV. It is difficult to determine the number of new HCV infections, as most acute cases are not noticed clinically.

Parenteral exposure to the hepatitis C virus is the most efficient means of transmission. The majority of patients infected with HCV in Europe and the United States acquired the disease through intravenous drug use or blood transfusion, which has become rare since routine testing of the blood supply for HCV began. The following possible routes of infection have been identified in blood donors (in descending order of transmission risk):

• Injection drug use
• Blood transfusion
• Sex with an intravenous drug user
• Having been in jail more than three days
• Religious scarification
• Having been struck or cut with a bloody object
• Pierced ears or body parts
• Immunoglobulin injection

Very often in patients with newly diagnosed HCV infection no clear risk factor can be identified.

Factors that may increase the risk of HCV infection include greater numbers of sex partners, history of sexually transmitted diseases, and failure to use a condom. Whether underlying HIV infection increases the risk of heterosexual HCV transmission to an uninfected partner is unclear. The seroprevalence of HCV in MSM (men who have sex with men) ranges from about 4 to 8%, which is higher than the HCV prevalence reported for general European populations.

The risk of perinatal transmission of HCV in HCV RNA positive mothers is estimated to be 5% or less (Ohto 1994). Caesarean section has not been shown to reduce transmission. There is no evidence that breastfeeding is a risk factor.

Hemodialysis risk factors include blood transfusions, the duration of hemodialysis, the prevalence of HCV infection in the dialysis unit, and the type of dialysis. The risk is higher with in-hospital hemodialysis vs peritoneal dialysis.

Contaminated medical equipment, traditional medicine rites, tattooing, and body piercing are considered rare transmission routes.

There is some risk of HCV transmission for health care workers after unintentional needle-stick injury or exposure to other sharp objects.

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Simple music from John Lennon - Imagine (official video)

Imagine - John Lennon

Imagine - John Lennon, A song about humanism.

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Signs and Symptoms of Hydrocephalus

The signs and symptoms of hydrocephalus in infants and children vary depending on their age, the degree of hydrocephalus at presentation, the primary etiology, and the time over which the hydrocephalus develops. Ventriculomegaly can progress without obvious signs of increased intracranial pressure because of the plasticity of the infant brain and the ability of the cranium to expand.

In full-term infants, signs often include macrocephaly and progressively increasing occipital frontal head circumference, crossing percentile curves. Normal head circumference for a full-term infant is 33–36 cm at birth. A normal head circumference increases by approximately 2 cm/month during the first 3 months, by 1.5 cm/month during the 4th and 5th months, and by about 0.5 cm/month from months 6–12.

Signs and symptoms of hydrocephalus in children:

Premature infants

• Apnea
• Bradycardia
• Hypotonia
• Acidosis
• Seizures
• Rapid head growth
• Tense fontanel
• Splayed cranial sutures
• Vomiting
• Sunsetting eyes

Full-term infants

• Macrocephaly
• Rapid head growth
• Decreased feeding
• Increased drowsiness
• Tense fontanel
• Vomiting
• Distended scalp veins
• Splayed cranial sutures
• Poor head control
• Parinaud’s sign
• Sunsetting eyes
• Frontal bossing

Toddlers and older

• Headache
• Nausea
• Vomiting
• Irritability
• Lethargy
• Delayed development
• Decreased school performance
• Behavioral disturbance
• Papilledema
• Parinaud’s sign
• Sunsetting eyes
• Bradycardia
• Hypertension
• Irregular breathing patterns

 

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