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Basic Conditioning

Factors

1. Age

2. Gender

3. Developmental state;

a. Psychological, developed according to Erickson, self image & concept social relationships.

b. Cognitive, orientation, memory, concentration & calculation, knowledge, judgment, thought processes

c. Physical, weight & height, muscle mass & fat distribution

4. Relevant life experience:

a. How pt. has reacted in stress situations

b. How pt. reacted to similar situations with friends & family

c. Reaction to & perception of illness

d. Perception of health care, attitude about wellness/illness

e. Level of stress & anxiety

5. Health care system:

a. Present dx, date admitted signs & symptoms of illness, date of surgery, significant exam, & procedures.

b. Past medical history

6. Health state:

a. Information about aspects of human structure & functioning at moments in time, reason for seeking treatment, signs & symptoms, VS, physical assessment.

7. Socio cultural orientation:

a. Role in family/marital status

b. Ethnic background

c. Religion

d. Education/intellectual level

e. Occupation

f. Recreational activities, hobbies, social & leisure activities.

8. Available resources:

a. Financial status

b. Insurance

c. Social security, other benefits

d. Support Systems

e. Time

f. Other

Power Components

1. Aware of self & surrounding: level of consciousness, orientation.

2. Physical energy to carry out self-care actions: sufficient energy, pulse, respiration, c/o fatigue, slow/hyperactive, enough sleep, eats enough, weight, mental state, growth spurt, surgery, illness, pregnancy, prioritizes energy use, limits energy use to prevent injury.

3. Ability to control body position & movements: adequate gross & fine motor skill, full/limited range of motion, state is able to do self care,

work, recreate.

4. Ability to reason: reason without defensiveness, denial, projection. Knows cause & effect. Reacts consistently & congruently to questions.

5. Motivation: Values self care & health. Knows importance of self care. Starts & follows through with good health care goals.

6. Ability to make & implement decisions regarding self-care: recognized problems with help, recognized won responsibility for actions, states goals, plans, implementation, & eval. Identifies supports, constraints, & conflicts in attaining goals.

7. Ability to acquire, retain & utilize knowledge: good attention span, short term memory, long term memory. Has knowledge of own health state, uses knowledge regarding own health state & demonstrates this knowledge. Use appropriate resources for health care knowledge.

8. Repertoire of skills: self care actions that are carried out

9. Ability to order self care actions: prioritizes, organizes.

10. Ability to perform self care actions consistently & to fit them into personal, family & community life:

maintains self care regimen, integrates self care regimen into daily life.

Universal Self-Care Requisite Assessment Guide

1. Hazards to life, functioning, & well-being, (biological, physical, chemical, & mental): Ventilation, lighting, humidity, noise, odors, arrangement of objects in the physical environment, equipment, orientation-disorientation to environment, use of safety devices, (rail, restraints, etc.), sensory deficits (hearing, visual, tactile, kinesthetic), aesthetic factors, presence of infectious disease or infected wound barriers to cross infection, known allergies, potential or existing hazards, meds(s/e, toxic effects), heat/cold treatments, impaired skin integrity (incision, IV, foley, etc.), impaired immune system, WBC.

2. Maintenance of sufficient intake of air: Airway patency, respiratory rate, depth, character, breath sounds, posture, body position, cough, secretions, skin color, color of mucous membranes, respiratory aides, tolerance to activity, history of pulmonary or circulatory problems, environmental factors, apical pulse, peripheral pulses (volume, rate, rhythm), blood pressure (position, arm, postural changes),medications affecting respiratory/circulatory system, present body temperature, recent temperature variations, environmental factors affecting vital signs, disease conditions present that afect respiratory/circulatory status, peripheral circulation, TED hose. Laboratory & diagnostic studies: chest x-ray, pulm function, blood gases, CBC, TIBC, clotting studies, etc.

3. Maintenance of a sufficient intake of water: Avg. daily fluid intake & output balance or imbalance of intake & output, sources of intake & loss, edema, presence, absence, location, degree, sources of intake & loss relating to potassium, chloride, sodium, bicarbonate, disease & disorders affecting fluid balance, state of hydration, dehydration. Lab & diag. studies: Hct, Hg, Sp. Gr., Lytes.

4. Maintenance of a sufficient intake of food: Ht, wt, BMI gain, loss pattern, usual dietary habits, present dietary intake, usual meal spacing, food preferences, age & caloric requirements, attitudes toward eating, non-oral means of intake (TPN, NG, Gtube), meds affecting absorption, nausea & vomiting, eructation, flatulence, swallowing ability, condition of mouth, teeth & gums, GI motility, appetite (hunger, satiety, anorexia), condition of hair & nails.

5. Provision of care associated with eliminative processes & excrements: Skin color appearance, rashes, character of any lesions present, areas of redness, pigmentation, factors predisposing to skin breakdown, cleanliness, warmth, odor, usual hygiene habits & practices in relation to elimination, secretions, pruritus, bladder habits, frequency of micturation, characteristics of urine (color, odor, unusual constituents), incontinence, retention, aids to

Universal Self-Care Requisite Assess. Guide, Cont.

urine elimination, meds influencing GI system, artificial orifices for urine elimination & methods of care. Required laboratory test: U/A, clean voided specimens, etc.) bowel habits, time of usual defecation, alteration with hospitalization, frequency & character (amount, color, consistency, odor, unusual constituents), aids to elimination, meds affecting elimination, artificial orifices for bowel elimination & method of care, flatulence, fecal impaction, incontinence, hemorrhoid, method of eliminating (toilet, commode, bedpan). Lab & diagnostic studies: O&P, fecal fat, guaiac, GI series, endoscopy. BUN, Creatinine, Lytes.

6. Maintenance of a balance between activity & rest: Condition of skin at pressure points, activity restrictions, limitations, mechanical devices for assistance, gait endurance, general movement (coordination, stability), muscle strength, tone, mass, range of motion, posture, handedness, deformities, paralysis, weakness, rehabilitative measures, usual sleep patterns, alterations due to hospitalization, meds affecting sleep, usual bedtime & arising time, number of arousals, position for sleep measures to induce sleep (drinks, reading, meds), environmental conditions, number & length of naps, exercise, type, frequency, duration, presence of pain or discomfort (location, duration, degree, extent, character, precipitating factors), use of aids to relieve pain, discomfort (meds, comfort measures), response to meds or comfort measure, conditions lessening ability to tolerate pain, pain threshold.

7. Maintenance of a balance between solitude & social interaction: Presence/absence of roommate, solitary, social activities, visitors (who, when, how many), phone calls, flowers, gifts, presence of TV/radio/phone, depression, withdrawn, anxious, isolates self, ability to leave hospital room, isolation requirements, arrangement of environment conducive for visitors, presence, absence of uninterrupted time of visitors, level of consciousness, ability to verbalize, communication skill living arrangements at home, spiritual assessment, meds altering mood, emotions, awareness of reality, presence, absence of privacy.

8. Promotion of normalcy: Threats to biological integrity or self esteem, actual or potential, interference with necessary satisfaction of basic needs, loss of control related to decisions & choices affecting one’s self loss of identity, changes in body image, loss of personal space, effects of health status on sexuality, effects of health status on role with family & significant others, presence/absence of pain, modification of life style or self concept due to illness, possession/lack of self esteem including feelings of dependence/independence, desire, knowledge, & ability to engage in self-care.

Developmental Self-Care Requisite Assessment Guide

1. Maturational

1. Environment: physical setting, people, economic & social components

2. Age

3. Education

4. Present knowledge, skills, attitudes & ability to acquire the following development stages:

a. Intrauterine stages of life & the process of birth

i. Nutrition

ii. Smoking, drinking, drugs

iii. Prenatal care

iv. Childbirth classes

b. Neonatal stage of life

i. Term, premature, post term

ii. SGA, AGA, LGA

iii. Infancy

iv. Childhood, adolescence, entry into adulthood Erickson

c. Pregnancy

i. Planned, unplanned

ii. Wanted, unwanted

iii. Age

iv. Single parent

v. Prenatal care

vi. Ability to care for child

Develop. Self-Care Requisite Assess. Guide, Cont.

2. Situational.

1. Education deprivation

a. lack of knowledge

b. ability to learn

c. past learning experiences

2. Problems of social adaptation

3. Failure of individuation

a. Erickson’s developmental stages & signs of failure to attain

4. Loss of relatives, friends, associates

a. When did loss occur?

b. Why & how did loss occur?

c. Who was lost & what was the meaning of the loss to the person

d. Is the loss potential, temporary or permanent?

5. Loss of occupational security & or possessions

a. When, why & how did loss occur

b. Is loss potential, temporary or permanent?

6. Abrupt change of residence to an unfamiliar environment

a. Why, how, & when did change occur

b. Is it potential, temporary or permanent?

7. Status-associated problems

a. Will patient status be affected by condition?

b. Will it be readily observable or able to be concealed?

c. Is it potential, temporary or permanent?

8. Poor health or disability

a. How does it affect ADLs?

b. How does it affect ability for growth, development & maturation?

c. Is it potential, temporary or permanent?

9. Oppressive living conditions.

a. How do they affect ability to deal with conditions?

b. How long have they been this way?

c. What is the potential for change?

10. Terminal illness & impending death

a. pt. & family awareness.

b. Stage of death & dying Kubler-Ross

c. Support systems available.

d. Cause of illness.

Health Deviation Self-Care Requisite Assessment Guide

1. Seek/secure medical assistance with exposure/evidence of conditions associated with pathology.

a. Knowledge of cause & effects of pathological state

b. Knowledge of signs & symptoms of pathological state.

c. Willingness to seek & secure medical assistance

d. Ability & resources to seek & secure medical assistance.

2. Be aware/attend to effects of pathological state.

a. Knowledge of effects & signs & symptoms.

b. Effects, signs & symptoms of treatment procedures & meds.

c. Ability to gain the above knowledge

d. Alertness, awareness.

e. Ability to take action for untoward effects.

3. Carry out medically prescribed measures related to prevention, regulation, compensation for pathology.

a. Knowledge of medically prescribed measures.

b. Ability or willingness to learn.

c. Motivation to carry out measures.

d. Mental & physical abilities to carry out the measures.

4. Be aware, attend to, regulate discomforting or deleterious effects of prescribed measures.

a. Knowledge of the effects & their signs & symptoms

b. Knowledge of means to control these effects

c. Ability to learn.

d. Ability to be aware of & attend to the effects.

e. Physical ability to carry out control measure.

f. Willingness to be aware of & take care of the effects.

5. Modify self-concept in acceptance of particular state.

a. Self esteem, self-concept

b. Behavior as it related to the particular state verbal, nonverbal

c. Changes in body image, loss of control, identity, status

& satisfaction of basic needs as related to health-state.

d. Meaning of above changes to the individual

6. Learn to live with effects of health state &/or prescribed measure so that the life-style promotes personal development.

a. Knowledge of the health state & prescribed measures.

b. Past history of self-care as it relates to the health state & prescribed measure. c. Ability to learn d. Willingness to alter life-style e. Resources & support system necessary to assist person to alter life-style.

f. Meaning of change in lifestyle to individual.

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