Assessing Activities of Daily Living and Sleep Patterns

1. Assessing Activities of Daily Living and Sleep Patterns Practicum of Health Science Technology 2009 - 2010

2. Objectives • Discuss the importance of balance between activity and sleep in a patient’s life • Describe the factors affecting activities of daily living • Identify interview questions used to assess personal care, family responsibility, work, school, recreational, and socialization activities for an adult and for a child. • Describe rapid eye movement sleep and the four stages of non-rapid eye movement sleep

3. Objectives • Describe the factors affecting sleep • Compare and contrast disorders of initiating and maintaining sleep, disorders of excessive sleepiness, disorders of the sleep-wake cycle, and parasomnias • Phrase representative interview questions that assess a client’s sleep patterns

4. Introduction • Maintaining a constant balance between daily activities and sleep is vital to the promotion and maintenance of physiologic and psychosocial health. • Daily activity affects a person’s ability to sleep soundly, and in turn, the quality of sleep affects a person’s ability to carry out daily activities

5. Activities of Daily Living (ADLs) • Include five components: - Personal Care - Family Responsibility - Work or School - Recreation - Socialization

6. Factors Affecting ADLs • Age • Developmental status • Culture • Physiologic health • Cognitive function • Psychosocial function • Stress level • Biological rhythms

7. Age & Developmental Status • A client’s age and developmental status provide clues to the patient’s interests and abilities, as well as how the patient may react to an inability to perform ADLs • When progressing from infancy to adulthood, an individual gradually shifts from dependence to independence in performing the five ADL components • Assess the clients age and developmental level when assessing the level of independence and ability to assume responsibility for ADLs.

8. Culture • A person’s culture – learned values, beliefs, customs, and behaviors – affects interests and roles, sometimes depending on sex. • Remember, a groups values, and beliefs can change over time, allowing altered roles and relationships. • Determine the influence of a person’s cultural heritage as well as any changes in values and customs when assessing ADLs

9. Physiologic Health • A patient’s physiologic health affects the ability to participate in ADLs, consider the functional status of each body system when performing as assessment

10. Cognitive Function • Cognitive function refers to the process of perceiving, organizing, and interpreting sensory stimuli to think and solve problems • Mental processes contributing to cognitive function include: attention, memory, and intelligence.

11. Cognitive Function • An alteration in any aspect of cognitive function may interfere with logical thinking or abstract reasoning and therefore prohibit independent performance of ADLs • During ADL assessment, analyze the patient’s level of cognitive function, then use that information to formulate questions and to structure teaching in a manner appropriate to the patient

12. Psychosocial Function • Refers to a person’s ability to process past and present information in a manner that provides a realistic view of oneself, one’s life, and others • Process involves a complex interaction between intrapersonal and interpersonal behaviors

13. Intrapersonal Behaviors • Those caused by an altered self concept or emotional instability

14. Interpersonal Behaviors • Communication problems, impaired social interactions, or dysfunctions in role performance

15. Stress Level • Stress is a nonspecific, physical response to any king of demand • The factors that produce stress are called stressors, can originate from within the body or from the environment and can disrupt the body’s equilibrium • Stressors can be physiologic, such as injury, or psychological, such as the loss of a loved one.

16. Stress Level • Stress is necessary for normal growth and development • It can have negative and positive effects on a patient’s ability to participate in ADLs

17. Positive vs Negative • Whether a stressor produces positive or negative results depends on several factors, the first is perception. • Magnitude or the intensity of the stressor affects the patient’s response • The number of concurrent stressors as well as their frequency and duration also affects the type of response • Experience with stress and past coping measures influence how a patient will face new stressors.

18. Assessment • Stress affects people of all ages and affects a patient’s stress level is essential • To perform an accurate assessment, evaluate the characteristics of the stressor, determine the patient’s perception of the stressor, and discover the patient’s method of coping.

19. Biological Rhythms • Rhythmic biological clocks, known as biological rhythms, help patients adjust to the surrounding physical environment and maintain internal homeostasis • Various biological rhythms beginning by the third week of life and continuing thereafter, operate on cycles of hours, days or months

20. Biological Rhythms • One type of rhythm, called a circadian rhythm, operates on a cycle of approximately 24 hours • Different circadian rhythms help regulate biological and behavioral activities, including sleep and wakefullness, body temperature, and hormone levels.

21. Biological Rhythms • Many factors contribute to an individuals circadian rhythm - Environmental - Social

22. Environmental Factors • Environmental factors such as the hours of daylight and darkness and the seasons of the year regulate many daily actitivies • These environmental cues establish the appropriate times to eat, work, and relax

23. Social Factors • Social factors such as work or school schedules, household routines, and social activities also influence circadian rhythms • Hospitalization, shift work, or stress can disrupt these circadian rhythms and can result in physical illness, psychological discomfort, or impaired cognition • Disrupted circadian rhythms can compromise the muscle strength and coordination required to perform a task or the attention, memory, and concentration needed to complete an activity • Once disrupted, a circadian rhythm may require up to several weeks to return to normal

24. Assessing ADLs • During the interview, the health care professional uses observation to gather information on ADLs. • During the interview gather data from the patient and family members, and focus on their perceptions of the patient’s ability to perform ADLs, and identify the patient’s and family’s goals for functioning.

25. Assessing ADLs • Determine whether the patient and the family have realistic views, have developed attainable goals, and have similar perspectives • Observe the patient performing ADLs when possible • Use the assessment to ascertain the patient’s functional status in performing ADLs • Determine whether the patient can function independently, if the client requires assistance of a person or device, or if the patientdepends totally on others

26. Assessing ADLs • If the patient needs assistance, determine the amount and type required • If the patient depends on devices, inquire about the type of device and its adequacy in resolving the problem • Also evaluate the possible need for other devices

27. Questions and Rationales

28. Personal Care Activities

29. Do you have any difficulty standing, walking, or climbing stairs? Can you get in and out of a chair? Can you get in and out of bed? What assistive devices do you use to aid in mobility?

30. Rationale • An alteration in mobility may hinder a patient’s ability to engage in other ADLs.

31. Can you open packages and containers? Can you use utensils for eating? Can you cut your food? Do you have any other problems feeding yourself? What times do you usually eat? Who prepares your meals? Where do you eat your meals? With whom do you eat?

32. Rationale • These questions help investigate the patient’s ability to prepare meals and to eat independently. • The ability to feed oneself is an important personal care activity

33. Can you use the toilet alone, or do you require assistance? Do you have any problems with bowel or bladder control? If so, how do you manage these problems? Do you use any assistive devices for elimination, such as catheters or colostomy bags? If so, can you care for these devices? How have elimination problems affected your other activities?

34. Rationale • An elimination problem can interfere with work, school, recreational, and socialization activities • These questions give the patient the opportunity to discuss problems, fears, and anxieties regarding elimination, and give the health care provider an opportunity to teach the patient or family ways to manage these problems.

35. Do you have any difficulties with dressing and grooming? If so, are these problems more pronounced on the left side, the right side, the upper part, or the lower part of your body? Can you fasten buttons, snaps and zippers? Is dressing easier with certain types of clothing?

36. Rationale • Musculoskeletal or nueromuscular abnormalities can disrupt fine or gross motor coordination, making dressing and grooming activities that adults perform independently difficult for the patient

37. Family Responsibilities

38. What are your living arrangements? Does your home need structural changes so that you can fulfill your family responsibilities and perform ADLs? Do you have any problems with food management, such as shopping or food preparation? Can you complete your own laundry? What type of cleaning can you do? Are you having any difficulties managing your money, such as getting to a bank? Does your family responsibility include caring for any sick or disabled persons in the home? If so, do you have any difficulties with this role? Do you care for a pet in your home?

39. Rationale • These questions help investigate the structure and composition of the patient’s family, the patient’s developmental status, and the responsibilities the patient has assumed in the family • A client who cannot perform usual family responsibility activities may develop role and relationship problems

40. Work and School Activities

41. What does your typical day involve? Do you work outside the home? Where and what type of work do you do? How many hours per week do you work? What is your work schedule like? Do you have any conflicts between your work schedule and other responsibilities or ADLs? What is your job like? Is work mainly a source of satisfaction or frustration? Do you participate in any volunteer work?

42. Rationale • These questions help investigate the type of work the client participates in and the role of work in the client’s life • A client with a heavy, stressful work schedule may feel that he or she is neglecting family and self, causing guilt feelings that add to the stress

43. What do you see yourself doing in the future? How do you feel about retirement? What plans have you made for retirement?

44. Rationale • These questions help investigate the patient’s point of view of retirement, including alterations in ADLs caused by retirement

45. Are your going to school? If so, where and for what purpose? What do you like most about school? What do you like least about school? Do you have any difficulties balancing school activities with other life responsibilities?

46. Rationale • These questions help investigate the nature and demands of any schoolwork in which the client participates, and help assess the effects of school on other activities • A patient’s whose school activities interfere with personal care activities, family responsibilities, or work activities may benefit from counseling

47. Recreational Activities

48. What do you do when you are not working or in school? How so your days off differ from your work or school days? How much recreational time do you have in a day and in a week? Are you satisfied with the amount of recreational time and what do you do during that time?

49. Rationale: • These questions help investigate the type, amount, timing, and purpose, and benefits of the client’s recreational and physical exercise activities. A decrease in the usual activity levels may results from a physical disorder, and may lead to an emotional problem, such as depression.

50. Socialization Activities