Resident Evaluation Form Toileting

Transcription

1 Resident Name Date Evaluator Directions: Use this information to supplement your existing assessment. Exercise examples designed to improve skill areas are included with this resource. Flexibility Can bend over Fine motor control Manages zippers Manages buttons Grip Strength Uses grab bars Holds toilet tissue Turns faucet on Perineal muscles Can stop the flow of urine Hand eye coordination Gets toilet tissue Brings toilet paper to perineum Able to move arms in sufficient directions to allow for dressing/undressing and wiping

2 Upper body strength Can open bathroom door Lower body strength Can raise body from toilet Balance Is able to walk without sway or instability Is able to remove clothing and replace clothing without assistance Smell Is able to detect odors Vision Can locate bathroom Can locate toilet paper Can locate incontinence supplies Touch sensitivity Can feel pressure Can feel wetness Cognitive ability Is able to locate the bathroom Remembers to undress before voiding

3 Remembers to use toilet tissue Remembers to wash hands after using bathroom Health issues Takes a diuretic Has a urinary tract infection Has arthritis Becomes short of breath while toileting Experiences incontinence when laughing, sneezing, or standing from chair Experiences pain with urination Complains of abdominal fullness or pressure Other health issues

4 Exercise Suggestions to Improve Specific Skills Just doing of Daily Living (ADLs) is good exercise whether the resident does them independently or with some assistance. The activities suggested here can supplement the exercise obtained by doing ADLs but does not replace it. A resident should not engage in a new exercise program without approval of primary medical doctor. Use exercise videotapes appropriate for the specific audience. Resident Name Date Evaluator Check if needed Skills to Improve Suggested activities Check if completed Shoulder and elbow flexibility Waist flexibility Fine motor control Hand eye coordination Range of motion in shoulders Steadiness Grip strength Range of motion Swimming; water aerobics; stretching exercises Stretching exercises Put together puzzles, sort coins, play checkers, paint or draw, knitting, crocheting, crafts; play dominos; send cards to friends Playing cards, knitting, crocheting, crafts Raising arms over head; putting hands behind back; yoga postures that involve those actions See lower body strength exercises; See also, endurance exercises Squeezing a tennis ball; squeezing putty Swimming; water aerobics; gardening

5 Check if needed Skills to Improve Suggested activities Check if completed Upper body strength Lower body strength Endurance Balance Perineal muscles Vision Hearing Smell and taste Touch sensitivity in fingers, skin, mouth Cognitive ability Weights lifting, swimming, catching a ball, playing pool Walking, biking, ride stationary bike; Toe raises; See also, balance activities Walking, biking, sitting upright in a chair Walking, biking, line dancing, standing on one foot, gardening Practice the Kegel exercise daily Wear corrective lenses; use magnifying tools Wear corrective hearing aids; use head sets; turn on subtitles on television and films Evaluate medication side effects; Report loss of smell and taste to the resident s medical doctor; report loss to dentist Have the resident s doctor evaluate the cause of a loss of sensitivity; Protect hands and feet if sensation is decreased; Be aware of temperature (extreme cold or heat) and use gloves; Use canes and other assistive devices. Play board games, do crossword puzzles, read; play dominos Other