Self-Care Deficit

Self-Care Deficit

• Impaired ability to perform or complete activities of daily

living for oneself, such as feeding, dressing, bathing,
toileting.
Related Factors

• Here are some factors that may be related to Self-Care

Deficit:

• Activity intolerance
• Cognitive impairment
• Decreased motivation
• Decrease strength and endurance
• Depression
• Environmental factors
• Fatigue, weakness
• Impaired mobility or transfer ability
• Musculoskeletal impairment
• Neuromuscular impairment
• Perceptual impairment
• Pain, discomfort
• Severe anxiety
Defining Characteristics

• Self-Care Deficit is characterized by the following signs

and symptoms:

• Disorderly appearance, strong body odor

• Frustration
• Impaired ability to put on or take off clothing
• Inability to ambulate autonomously
• Inability to bathe and groom self independently
• Inability to control temperature of water
• Inability to do common tasks such as telephoning and
writing
• Inability to dress self autonomously
• Inability to feed self independently
• Inability to move from bed to wheelchair
• Poor personal hygiene
• Problems in finishing toilet tasks
Goals and Outcomes

• The following are the common goals and expected

outcomes for Self-Care Deficit:

• Patient identifies useful resources in optimizing the

autonomy and independence.
• Patient demonstrates lifestyle changes to meet self-care
needs.
• Patient recognizes individual weakness or needs.
• Patient safely executes self-care activities to utmost
capability.
 Nursing Assessment
Assessment
Assess the patient’s strength to accomplish ADLs
efficiently and cautiously on a daily basis using a proper
assessment tool, such as the Functional Independence
Measures (FIM).
Determine the specific cause of each deficit (e.g., visual
problems, weakness, cognitive impairment).
Consider the patient’s need for assistive devices.
Rationales
The patient may only need help with some self-care
measures. FIM measures 18 self-care items related to
eating, bathing, grooming, dressing, toileting, bladder
and bowel management, transfer, ambulation, and stair
climbing.
Various etiological factors may need more explicit
interventions to enable self-care.
Assistive devices improve confidence in performance of
ADLs.
 Nursing Assessment
Assessment Rationales

Recognize choice for food, personal care items, and The patient will be eager to submit himself or herself to
other things. the treatment regimen that supports his or her individual
preferences.

Evaluate gag reflex or the need for swallowing Absence of gag reflex or inability to chew or swallow
assessment by a speech therapist prior to initial oral properly may lead to choking or aspiration.
feeding.

Verify the need for home health care after discharge. Shortened hospital stay have resulted in patients being
more debilitated on discharge and therefore requiring
more assistance at home. Occupational therapists have
access to a wide range of self-help devices.
 Nursing Assessment
Assessment Rationales

Monitor impulsive behavior or actions indicative of This may imply the demand for supplementary
altered judgment. interventions and management to guarantee safety or
security.
 Nursing Interventions
Interventions Rationales

Establish short-term goals with the patient. Helping the patient with setting realistic goals will reduce
frustration.

Guide the patient in accepting the needed amount of Patient may require help in determining the safe limits of
dependence. trying to be independent versus asking for assistance
when necessary.

Present positive reinforcement for all activities attempted; External resources of positive reinforcement may
note partial achievements. promote ongoing efforts. Patients often have difficulty
seeing progress.
 Nursing Interventions
Interventions Rationales

Render supervision for each activity until the patient The patient’s ability to perform self-care measures may
exhibits the skill effectively and is secured in independent change often over time and will need to be assessed
care; reevaluate regularly to be certain that the patient is regularly.
keeping the skill level and remains safe in the
environment.

Implement measures to promote independence, but An appropriate level of assistive care can prevent injury
intervene when the patient cannot function. from activities without causing frustration. Nurses can be
key in helping patients accept both temporary and
permanent dependence.

Boost maximum independence. The goal of rehabilitation is one of achieving the highest
level of independence possible.
 Nursing Interventions
Interventions Rationales

Apply regular routines, and allow adequate time for the An established routine becomes rote and requires less
patient to complete task. effort. This helps the patient organize and carry out self-
care skills.

Allow the patient to feed himself or herself as soon as It is possible that the dominant hand will also be the
possible (using the unaffected hand, if appropriate). affected hand if there is upper extremity involvement.
Assist with setup as needed.

Ensure the patient wears dentures and eyeglasses if Deficits may be exaggerated if other senses or strengths
required. are not functioning optimally.
 Nursing Interventions
Interventions Rationales

Place the patient in a comfortable position for feeding. Proper positioning can make the task easier while also
reducing the risk for aspiration.

Provide patient with proper utensils (e.g., wide-grip These things expand possibilities of success.
utensils, rocking knife, plate guard, drinking straw) to aid
in self-feeding.

Assure that the consistency of diet is suitable for the Thickened semisolid foods such as pudding and hot
patient’s ability to chew and swallow, as assessed by the cereal are most easily swallowed and less likely to be
speech therapist. aspirated.
 Nursing Interventions
Interventions Rationales

Provide privacy during dressing. The need for privacy is fundamental for most patients.
Patients may take longer to dress and may be fearful of
breaches in privacy.

Use appropriate assistive devices for dressing as The use of buttonhook or loop-and-pile closures on
assessed by the nurse and occupational therapist. clothes may make it possible for a patient to continue
independence in this self-care activity.

Suggest elastic shoelaces or Velcro closures on shoes. The closures eliminate tying, which can add to
frustration.
 Nursing Interventions
Interventions Rationales

Give frequent encouragement and aid with dressing as Assistance can reduce energy expenditure and
needed. frustration. However, care needs to be taken so the care
provider does not rush through tasks, negating the
patient’s attempts

Utilize wheelchair or stationary chair. Dressing requires energy. A chair that provides more
support for the body than sitting on the side of the bed
saves energy when dressing.

Establish regular activities so the patient is rested before A plan that balances periods of activity with periods of
activity. rest can help the patient complete the desired activity
without undue fatigue and frustration.
 Nursing Interventions
Interventions
Consider the use of clothing one size larger.
Inform family members to allow the patient perform self-
care measures as much as possible.
Consider or use energy-conservation techniques.
Rationales
A large size guarantees easier dressing and comfort.
Reinstitutes feeling of independence and promotes self-
esteem and improves rehabilitation process. Note: This
may be very hard and discouraging for the significant
other or caregiver, depending on extent of disability and
time needed for the patient to accomplish activity.
This saves energy, decreases fatigue, and improves
patient’s capability to execute tasks.
 Nursing Interventions
Interventions Rationales

Educate family and significant others to promote This displays caring and concern but does not hinder
autonomy and to intervene if the patient becomes tired, with patient’s efforts to attain autonomy.
not capable of carrying out task, or become extremely
aggravated.

Assess and note prior and present patterns for toileting; The efficacy of the bowel or bladder program will be
introduce a toileting routine that factors these habits into improved if the natural and personal patterns of the
the program. patient are taken into consideration.

Assess patient’s ability to verbalize necessitate to void Patient may have neurogenic bladder, is lacking
and/or capacity to use urinal, bedpan. Bring patient to the concentration, or be able to verbalize needs in acute
bathroom at regular or intermittent intervals for voiding if recovery phase, but often is able to recover independent
suitable. control of this function as recovery develops.
 Nursing Interventions
Interventions Rationales

Entertain patient input in planning schedule. Patient’s worth of life is improved when wishes or likes
are taken into consideration in daily activities.