RN FIM Competency 2nd Qtr
Mrs P is a 75 y. O. Married woman who lives with her husband. She was in fair health until 3/15/13 when she had a left anterior cerebral artery occlusion. She was admitted to the acute care hospital, became medically stable and was transferred to SCC for rehabilitation.
- 1.EATING: Mrs. P passed her modified barium swallow, with safe swallow for all consistencies. She is left handed and is able to pick up a utensil and feed herself with her right hand. She needs help opening milk containers and removing lids. What level of assistance is needed?
- A.
2 or Max Assist
- B.
4 or Min Assist
- C.
7 or Independent
- D.
5 or Supervision/Set up
- E.
3 or Mod Assist
- 2.GROOMING: Mrs. P is able to wash her face and hands, after much prompting by the helper. She brushes her teeth independently, after a helper finds the toothbrush for her and prompts her to initiate the task. She needs help brushing her hair. What level of assistance is needed? (Hint: Grooming consists of 4 tasks)
- A.
Min Assist - 4
- B.
Mod Assist - 3
- C.
Dependent - 1
- D.
Activity did not occur - 0
- E.
Supervision/Set up - 5
- 3.BATHING: Mrs. P has a delayed response when following commands or initiating tasks. She requires verbal cues and a helper must put the washcloth in her hand before she can begin to bathe. Mrs. P can then wash her chest, abdomen and left upper leg while a helper finishes the rest of the bathing. (Hint: How many areas of the body are included in bathing?)
- A.
4 or Min Assist
- B.
1 or Dependent
- C.
2 or Max Assist
- D.
6 or Mod I
- E.
3 or Mod Assist
- 4.DRESSING-UPPER BODY: Mrs. P needs a helper to remove her bra. She is in a lot of pain in her right upper extremity, and is unable to take either arm out of her shirt or pull it over her head without assistance. What level of assistance is needed?
- A.
Mod A - 3
- B.
Max A - 2
- C.
Dependent/Total Assist - 1
- D.
Supervision/set up - 5
- E.
Min A - 4
- 5.DRESSING - LOWER BODY: Mrs. P is able to lift her right leg so a helper can thread her underwear and pants. She is not able to lift her left leg. While in bed, Mrs. P is able to pull her underwear and pants up without help. She wears antiembolic stockings that are applied and removed by a helper. A helper applies and removes Mrs. P's shoes and socks. Patient performs less than 50% of lower body dressing. What level of assistance is needed?
- A.
Dependent - 1
- B.
Min Assist - 4
- C.
Mod I - 6
- D.
Max Assist - 2
- E.
Mod Assist - 3
- 6.TOILETING; When in a standing position, Mrs. P needs a helper to pull down her pants and adult brief. She is able to clean herself. The helper must pull up both pants and the adult brief. What level of assistance is needed?
- A.
Mod I - 6
- B.
Max Assist - 2
- C.
Dependent - 1
- D.
Mod Assist - 3
- E.
Activity did not occur - 0
- 7.BLADDER: Mrs. P is taking medication to help with bladder management. Half of her voids are incontinent. She is wearing a brief. A helper must change the brief for her when she is incontinent. The brief is successfully keeping her clothing and linen dry. What level of assistance is needed?
- A.
Mod I - 6
- B.
Max Assist - 2
- C.
Min Assist - 4
- D.
Supervision - 5
- E.
Dependent - 1
- 8.BOWEL: Though Mrs. P is aware when she needs to have a bowel movement , she still needs to wear a brief just in case. The first day of admission, while waiting for the staff to take her to the toilet, she became incontinent. The brief was soiled but not her clothing or linens. The helper had to change her brief and clean her. What level of assistance is needed?
- A.
Max Assist - 2
- B.
Mod I - 6
- C.
Min Assist - 4
- D.
Dependent - 1
- E.
Supervision - 5
- 9.TRANSFERS; Bed/Chair/Wheelchair: Mrs. P does a stand pivot transfer from bed to the wheelchair. She needs a helper to arrange her wheelchair next to the bed, only requiring contact guard/steadying assistance. However, when moving from wheelchair to the bed, she needs some lifting assistance rather than just contact guard, but she still does the majority (or more than 50%) of the work in transferring from wheelchair to bed. What level of assistance is needed?
- A.
Supervision - 5
- B.
Min Assist - 4
- C.
Max Assist - 2
- D.
Mod Assist - 3
- E.
Dependent - 1
- 10.TRANSFERS; Toilet: Transferring onto a regular toilet seat, Mrs. P uses her quad cane and a helper provides verbal assistance to help her get situated on the toilet. Mrs. P needs just a slight amount of lifting assistance when rising from the toilet. What level of assistance is needed?
- A.
Supervision - 5
- B.
Min Assist - 4
- C.
Mod Assist - 3
- D.
Max Assist - 2
- E.
Dependent - 1
- 11.TRANSFERS; Tub/Shower: The unit's tub area is currently being remodeled, so Mrs. P does not attempt a tub transfer. Using her quad cane, she is able to walk into the shower and sit onto a shower bench with steadying assistance. She requires steadying assistance to stand up and walk out of the shower area. What level of assistance is needed?
- A.
Dependent - 1
- B.
Max Assist - 2
- C.
Min Assist - 4
- D.
Supervision - 5
- E.
Mod I - 6
- 12.COMPREHENSION: It is difficult to assess Mrs. P's comprehension for complex ideas, because she has such a great delay in response. With prompting, Mrs. P follows directions about her basic daily needs approximately 50%-74% of the time. The information she understands consists of more than just simple statements. What level of assistance is needed?
- A.
7 - No assistance required. Patient comprehends complex or abstract directions and conversation, and understands either spoken or written language.
- B.
3 - Moderate: Patient understands directions and conversations about basic daily needs and ideas 50-74% of the time.
- C.
1 - Total Assistance: Patient understands only simple, commonly used spoken expressions or gestures about basic daily needs less than 25% of the time, despite prompting.
- D.
5 - Comprehends directions and conversation about basic daily needs requiring prompting no more than 10% of the time to be understood.
- E.
4 - Minimal: Understands directions and conversations about basic daily needs and ideas 75-90% of the time.
- 13.EXPRESSION: Mrs. P communicates by gesturing and using one-word sentences. Staff members are usually able to understand the basic information that she is trying to express. When staff members need to prompt her to repeat herself more than 50% of the time, she becomes frustrated and waves them off, or laughs and cries inappropriately. What level of assistance is needed?
- A.
6 - No assistance required - Patient expresses complex or abstract ideas but requires a computer to assist with expressing ideas.
- B.
4- Minimal assistance - Patient expresses basic daily needs and ideas 75-90% of the time.
- C.
2 - Maximal Assistance required - Uses only single words or gestures to express basic needs; requiring prompting more than 50% of the time.
- D.
0 - activity did not occur
- E.
1 - Total Assistance - Expresses basic needs appropriately or consistently less than 25% of the time despite prompting
- 14.SOCIAL INTERACTION: Mrs. P is emotionally labile and inappropriate the majority of the time. When her physicians come in to see her on the morning rounds, she starts crying uncontrollably and when her nurses greet her in the morning, she laughs hysterically. Mrs. P is appropriate less than 50% of the time, successfully redirected by the staff more than 50% of the time. What level of assistance is needed?
- A.
7 - No assistance to re-direct needed. No activity limitations
- B.
5 - She requires redirection, only under stressful or unfamiliar conditions, but no more than 10% of the time, she is encouraged to participate.
- C.
1 - Requires total assistance all or most of the time. Patient is appropriate less than 25% of the time.
- D.
2 - Maximal direction needed. Patient is appropriate 25-49% of the time.
- E.
4 - Minimal/occasional direction. Patient is appropriate 75-90% of the time.
- 15.PROBLEM SOLVING: Mrs. P is able to tackle routine basic problems more than 50% of the time. Sometimes she needs verbal cues and prompts to come to an appropriate solution to the problem. What assistance is required to make appropriate decisions to solve problems?
- A.
7- None. Consistently carries out sequence of steps to solve complex problems.
- B.
3 - Moderate Assistance; Some direction needed. Patient solves routine problems 50-74% of the time.
- C.
1 - Total Assistance - All or almost all of the time. Patient solves routine problems less than 25% of the time.
- D.
5 - Only under stressful or unfamiliar conditions, but no more than 10% of the time.
- E.
6 - No assistance needed. Only mild difficulty but is able to self correct and/or requires extra time to solve complex problems.
- 16.MEMORY: Mrs. P recognizes her husband and children, but she needs occasional reminders about where she is, which way her room is, or how to use a call light. What level of assistance does she need?
- A.
4 - Minimal Assistance needed; Occasional prompting. Patient recognizes and remembers 75-90% of the time.
- B.
1 - Total Assistance needed: All or almost all of the time. Patient recognizes and remembers less than 25% of the time.
- C.
7 - None needed. No activity limitations
- D.
2 - Max Assistance; A lot of prompting. Patient recognizes and remembers 25-49% of the time.
- E.
5 - Only under stressful or unfamiliar conditions, but no more thatn 10% of the time.
- 17.Adult Briefs/Diapers are considered undergarments/underwear and should be assessed/observed when scoring for Toileting.
- A.
True
- B.
False
- 18.Nursing is responsible for documenting bowel and bladder level of assistance and number of accidents in MEDITECH every shift throughout the patient's admission, not just the FIM days.
- A.
True
- B.
False
- 19.If the patient is unable to perform half or more of the effort then you must choose either a 2- Max assist or 1-Total Assist.
- A.
True
- B.
False
- 20.If a patient is able to do their own intermittent self catheterization, but you have to gather the equipment for him/her, then the FIM score would be a 7 - Total independence. (HINT - look at the bowel and bladder grid for your answer)
- A.
True
- B.
False
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