RN 3rd Quarter FIM
Mrs. M is a 70 y. O, married white female who lives with her husband. She has PVD, Hypertension, DM and is obese. She had bilateral knee replacement on 8/14/13 due to degenerative joint disease and is transferred to SCC on 8/20/13 for acute rehab.
- 1.Eating - Mrs. M requires dentures to chew a regular diet without problems; she can feed herself independently. What is the FIM score?
- A.
6 or Mod I
- B.
5 or Supervision
- C.
2 or Max Assist
- D.
7 or Independent
- E.
4 or Min Assist
- 2.Grooming - Mrs. M keeps her grooming supplies in a basket at the sink. She does not need a helper to set her up. Once she is seated at the sink, while sitting on a chair, she is able to wash, rinse and dry her face and hands, clean her dentures and comb her hair. Mrs. M does not wear makeup. What is the FIM score?
- A.
6 or Mod I
- B.
4 or Min Assist
- C.
7 or Independent
- D.
5 or Supervision
- E.
1 or Total Assist
- 3.Bathing - Mrs. M is able to wash, rinse and dry her chest, abdomen and both arms. A helper has to wash rinse and dry both upper and lower legs/feet, perineal area and buttocks. (Start with the definition; how many body parts are included in the definition of bathing? Then calculate a percentage based on the definition.) What is the FIM score?
- A.
1 or Total Assist
- B.
5 or Supervision
- C.
3 or Mod Assist
- D.
2 or Max Assist
- E.
7 or Independent
- 4.Dressing: Upper Body - Mrs. M is not able to gather her clothes from their customary place. After the helper places them on her nightstand, she is able to apply and remove her bra and shirt on her own. What is the FIM score?
- A.
4 or Min assist
- B.
5 or Supervision
- C.
7 or Independent
- D.
1 or Total Assist
- E.
3 or Mod Assist
- 5.Lower Body: Dressing - Due to having had bilateral knee replacement, Mrs. M requires 2 helpers for undressing her lower body. She requires mod assist for removing her underwear and total assist to remove her pants, shoes and socks. What is the FIM score?
- A.
Activity did not occur because she was undressing, not dressing
- B.
6 or Mod I
- C.
2 or Max Assist
- D.
1 or Total Assist
- E.
4 or Min Assist
- 6.Toileting - During the first FIM Day, Mrs. M uses a bedpan when she needs to void. She needs a helper to pull down her pants and underwear. She requires help to clean herself and to pull up her pants and underwear. What is the FIM score?
- A.
1 or Total Assist
- B.
3 or Mod Assist
- C.
5 or Supervision
- D.
7 or Independent
- E.
4 or Min Assist
- 7.Toileting - By her third day of admission, Mrs. M can use the bedside commode. She is able to pull her own pants and underwear down, clean herself and pull her own pants and underwear up. However, she requires 1 helper to steady her during these 3 tasks. The helper does not assist with the tasks themselves, but the helper is touching or applying contact guard/steadying assist to help to the patient. What is the FIM score?
- A.
1 or Total Assist
- B.
3 or Mod Assist
- C.
4 or Min Assist
- D.
5 or Supervision
- E.
7 or Independent
- 8.Bladder Management - Since her surgery, Mrs. M has had some bladder urgency. During your shift, she had an accident wetting around the pad and onto her pants. A helper changed the bed and clothing for her. While lying in bed, she was able to place and remove the absorbent pads but required a staff member to moderately assist her onto the bedpan. What is the FIM score? Remember; there are 2 function modifiers for Bladder Management - 1. Level of Assistance and 2. # of accidents. If staff are changing linens or clothing after an accident, regardless of needing mod assist onto the bedpan, what is the FIM score?
- A.
1 or Total Assist
- B.
5 or Supervision
- C.
3 or Mod Assist
- D.
7 or Independent
- E.
4 or Min Assist
- 9.Bowel Management - Mrs. M has been continent of bowel since admission, with no accidents during your shift. She uses a bedpan on her own but needs a helper to stand by, just in case she needs assistance. The helper empties the bedpan. What is the FIM score?
- A.
1 or Total Assist
- B.
5 or Supervision
- C.
4 or Min Assist
- D.
6 or Mod I
- E.
2 or Max Assist
- 10.Transfers: Bed/chair/wheelchair - Using a walker, Mrs. M is able to stand up with the help of 1 person, and pivot into the wheelchair. You provide less than 50% of the lifting. The patient is able to do more than 50% but less than 75% of the task. What is the FIM score?
- A.
5 or Supervision
- B.
6 or Mod I
- C.
3 or Mod Assist
- D.
1 or Total Assist
- E.
3 or Mod Assist
- 11.Transfers: Toilet - Mrs. M uses a bedpan for toileting, with a helper emptying the bedpan after use. (hint; trick question)
- A.
1 or Total Assist
- B.
5 or Supervision
- C.
4 or Min Assist
- D.
0 or Activity did not occur
- E.
3 or Mod Assist
- 12.Comprehension - Mrs. M easily follows concrete commands during therapy sessions but needs occasional repitition. She has no hearing aid batteries and asked her husband to bring some in. .
- A.
6 or Mod I
- B.
5 or Supervision
- C.
2 or Max Assist
- D.
1 or Total Assist
- E.
7 or Independent
- 13.Expression - Mrs. M has no difficulty expressing herself . She is able to state her basic needs adequately to staff 90% of the time, and is currently calling her husband to make sure he brings the batteries in for her hearing aids.
- A.
3 or Mod Assist
- B.
1 or Total Assist
- C.
6 or Mod I
- D.
5 or Supervision
- E.
4 or Min Assist
- 14.Social Interaction - Though at times she is in pain and a little tearful, she talks with other patients encouraging them to participate and get stronger in their therapies.
- A.
1 or Total Assist
- B.
5 or Supervision
- C.
2 or Max Assist
- D.
0 or Activity did not occur
- E.
7 or Independent
- 15..Problem Solving - Mrs. M tends to overestimate her functional abilities and doesn't ask for help during lower body dressing for example; when her feet get caught in her pants, she needs a cue to initiate use of a reacher. She needs verbal cuing occasionally, less than 10% of the time, for problem solving during ADLs.
- A.
7 or Independent
- B.
5 or Supervision
- C.
3 or Mod Assist
- D.
1 or Total Assist
- E.
6 or Mod I
- 16.Memory - Mrs. M feels that her hospitalization has thrown her off kilter and she has come up with a daily planning system to remember the times and places of her therapy sessions, when visiting hours are, her room number, and the names of her rehab team.
- A.
3 or Mod Assist
- B.
4 or Min Assist
- C.
1 or Total Assist
- D.
7 or Independence
- E.
6 or Mod I
- 17.True or False: If you, the helper, is providing more than 50% of the effort to complete the task, the FIM score would be 3 - Mod Assist.
- A.
True
- B.
False
- 18.The definition of Bathing includes the washing, rinsing and drying of the face.
- A.
True
- B.
False
- 19.True or False: If you, the helper, only provide physical support, steadying, or contact guard while the patient on his/her own, completes the 3 tasks of Toileting, in Achieve, you would select "Incidental Assistance" NOT "Physical Assistance" for a FIM score of 4 - Min Assist.
- A.
True
- B.
False
- 20.The information you document in Meditech for Bowel and Bladder, that includes Level of Assistance and Device used must match the Bowel and Bladder documentation in Achieve.
- A.
True
- B.
False
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