Katz Index of Independence in Activities of Daily Living

Activities
Points (1 or 0) BATHING Points: __________ DRESSING Points: __________ TOILETING Points: __________ TRANSFERRING Points: __________ CONTINENCE Points: __________ FEEDING Points: __________ Total Points: ________

Independence
(1 Point) NO supervision, direction or personal assistance
(1 POINT) Bathes self completely or needs help in bathing only a single part of the body such as the back, genital area or disabled extremity (1 POINT) Get clothes from closets and drawers and puts on clothes and outer garments complete with fasteners. May have help tying shoes. (1 POINT) Goes to toilet, gets on and off, arranges clothes, cleans genital area without help. (1 POINT) Moves in and out of bed or chair unassisted. Mechanical transfer aids are acceptable (1 POINT) Exercises complete self control over urination and defecation. (1 POINT) Gets food from plate into mouth without help. Preparation of food may be done by another person.

Dependence
(0 Points) WITH supervision, direction, personal assistance or total care
(0 POINTS) Need help with bathing more than one part of the body, getting in or out of the tub or shower. Requires total bathing (0 POINTS) Needs help with dressing self or needs to be completely dressed. (0 POINTS) Needs help transferring to the toilet, cleaning self or uses bedpan or commode. (0 POINTS)Needs help in moving from bed to chair or requires a complete transfer. (0 POINTS) Is partially or totally incontinent of bowel or bladder (0 POINTS) Needs partial or total help with feeding or requires parenteral feeding.

Score of 6 = High, Patient is independent. Score of 0 = Low, patient is very dependent.

THE BARTHEL INDEX Activity

Patient Name: Rater Name: Date: Score

FEEDING 0 = unable 5 = needs help cutting, spreading butter, etc., or requires modified diet 10 = independent BATHING 0 = dependent 5 = independent (or in shower) GROOMING 0 = needs to help with personal care 5 = independent face/hair/teeth/shaving (implements provided) DRESSING 0 = dependent 5 = needs help but can do about half unaided 10 = independent (including buttons, zips, laces, etc.) BOWELS 0 = incontinent (or needs to be given enemas) 5 = occasional accident 10 = continent BLADDER 0 = incontinent, or catheterized and unable to manage alone 5 = occasional accident 10 = continent TOILET USE 0 = dependent 5 = needs some help, but can do something alone 10 = independent (on and off, dressing, wiping) TRANSFERS (BED TO CHAIR AND BACK) 0 = unable, no sitting balance 5 = major help (one or two people, physical), can sit 10 = minor help (verbal or physical) 15 = independent MOBILITY (ON LEVEL SURFACES) 0 = immobile or < 50 yards 5 = wheelchair independent, including corners, > 50 yards 10 = walks with help of one person (verbal or physical) > 50 yards 15 = independent (but may use any aid; for example, stick) > 50 yards STAIRS 0 = unable 5 = needs help (verbal, physical, carrying aid) 10 = independent TOTAL (0100):

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The Barthel ADL Index: Guidelines: 1. The index should be used as a record of what a patient does, not as a record of what a patient could do. 2. The main aim is to establish degree of independence from any help, physical or verbal, however minor and for whatever reason. 3. The need for supervision renders the patient not independent. 4. A patient's performance should be established using the best available evidence. Asking the patient, friends/relatives and nurses are the usual sources, but direct observation and common sense are also important. However direct testing is not needed. 5. Usually the patient's performance over the preceding 24-48 hours is important, but occasionally longer periods will be relevant. 6. Middle categories imply that the patient supplies over 50 per cent of the effort. 7. Use of aids to be independent is allowed.

GORDONS FUNCTIONAL HEALTH PATTERNS Organizes data into 11 functional groups that contribute to a persons overall health and well-being, quality of life and attainment of human potential 1. Health Perception and Management provide an overview of the individuals health status and health practices that are used to reach the current level of health or wellness History (subjective data) Clients general health Any colds in past year Most important things you do to keep healthy Use cigarettes, alcohol, drugs Perform self exams Accidents at home, work, school, driving In past, has it been easy to find ways to carry out doctors or nurses suggestions? What do you think caused current illness What actions have you taken since symptoms started Have your actions helped What things are most important to your health How can we be most helpful Done exercise every what 2. Nutritional-Metabolic This pattern describes nutrient intake relative to metabolic need History (subjective data) Typical Daily Food intake Use of supplements, vitamins, types of snacks Typical Daily Fluid intake Weight loss/gain; Height loss/gain Appetite Infant feeding Food or Easing: Discomfort, Swallowing difficulties, diet restrictions, able to follow Skin problems: lesions, Dryness Dental problems Examination (examples of objective data) Skin assessment, oral mucous membranes, teeth, actual weight/height, temperature Abdominal Assessment 3. Elimination Describes the function of the bowel, bladder and skin Through this pattern the nurse is able to determine regularity, quality, and quantity of stool and urine History (subjective data) Bowel elimination pattern (describe) Frequency, character, discomfort, problem with bowel control, use of laxatives (i.e. type, frequency), etc Urinary elimination pattern (describe) Frequency, problem with bladder control? (Describe) Excess perspiration Odour problems Body cavity drainage, suction, etc Examination (examples of objective data) If indicated, examine excretions or drainage for characteristics, colour, and consistency Abdominal assessment 4. Activity-Exercise This pattern centers on activity level, exercise program, and lesire activities History (subjective data) Sufficient energy for desired and/or required activities Exercise pattern? Type? regularity? Spare time (leisure) activities? (Child-play activities)

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Perceived ability for Feeding, Grooming, Bathing, General mobility, toileting, home maintenance, bed mobility, dressing and shopping Examination (examples of objective data) Demonstrate ability for above criteria -Gait? Posture? Absent body part? Range of motion (ROM) joints Hand grip? Can pick up pencil Respirations Blood pressure General appearance Musculoskeletal, cardiac and Respiratory Assessments Sleep-Rest Assesses sleep and rest patterns History (subjective data) Generally rested and ready for activity after sleep Sleep onset problems Dreams (Nightmares) Early awakening Rest-relaxation periods Examination (example of objective data) Observe sleep pattern and rest pattern Cognitive-Perceptual Assesses the abiltity of the individual to understand and follow directions, retain information, make decisions, and solve problems Also asesses the five senses History (Subjective data) Hearing difficulty? Hearing Aid? Vision? Wears glasses? Last checked? When last changed? Any change in memory? Concentration? Important decisions easy/difficult to make? Easiest way for you to learn things? Any difficulty? Any discomfort? Pain? Examination (examples of objective data) Orientation Hears whispers? Reads newsprint? Grasps ideas and questions (abstract, concrete) Language spoken Vocabulary level Attention span Role Relationship History (subjective data) Live alone? Family? Family structure? Any family problems you have difficulty handling (nuclear/extended family)? Family or others depend on you for things? How well are you managing? How families/others feel about your illness? Problems with children? Belong to social groups? Close friends? Feel lonely? (Frequency) Things generally go well at work? School Income sufficient for needs? Feel part of (or isolated in) your neighborhood? Examination (examples of objective data) Interaction with family members or others if present Value-Belief History (subjective data) Generally get things you want from life? Important plans for future? Religion important to you? Does this help when difficulties arise? Will being here interfere with any religious practices? Examination

 None 9. Self-Perception/Self-Concept History (subjective data) How do you describe yourself? Most of the time, feel good (not so good) about self? Changes in body or things you can do? Problems for you? Changes in the way you feel about self or body (generally or since illness started)? Things frequently make you angry? Annoyed? Fearful? Anxious? Depressed? Not able to control things? What helps? Ever feel you lose hope? Examination (examples of objective data) Eye contact. Attention span (distraction?) Voice and speech pattern Body posture Client nervous (5) or relaxed (1) (rate scale 1-5) Client assertive (5) or passive (1) (rate scale 1-5) 10. Coping/Stress Tolerance History (subjective data) Any big changes in your life in the last one or two years? Crisis? Who is most helpful in taking things over? Available to you now? Tensed or relaxed most of the time? When tense, what helps? Use any medication, drugs, alcohol to relax? When there is a big problem in your life, how do you handle them? Most of the time, is this/are these ways successful Examination None 11. Sexuality/Reproductive History (subjective data) Sexual relationships satisfying? Changes? Problems? Use of contraceptives? Problems? Female when did menstruation begin? Last menstrual period (LMP)? Any menstrual problems? Gravida/Para Examination (examples of objective data) None unless a problem is identified or a pelvic examination is warranted as port of full physical assessment