Self-Care Deficit – Nursing Diagnosis & Care Plan

By Gil Wayne, RN - October 16, 2016

Self-Care Deficit: Impaired ability to perform or complete activities of daily living for oneself,
such as feeding, dressing, bathing, toileting.

Activities of daily living or ADLs are defined as “the stuff we regularly do such as feeding
ourselves, bathing, dressing, grooming, work, homemaking, and leisure. However, there are
some that might have difficulties in performing self-care.

Self-care refers to those activities an individual performs independently throughout life to

promote and maintain personal well-being.

Self-Care Deficit is the inability of an individual to perform self-care. The deficit may be the
effect of temporary limitations, such as those one might experience while recovering from
surgery, or the result of gradual deterioration that erodes the individual’s ability or willingness
to perform the activities required to care for himself or herself. Also, patients who are suffering
from depression may not have the interest to engage in self-care activities.
Assisting in activities of daily living are skills required in nursing and as well as other professions
such as nursing assistants. The nurse coordinates services to maximize the independence of the
patient and to ensure that the environment the patient lives is safe and supportive of his or her
special needs.
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
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 is required in order to identify potential problems that may have lead to Self-Care
Deficit as well as name any episode that may happen during nursing care.

Assessment Rationales
Assess the patient’s strength to accomplish The patient may only need help with some
ADLs efficiently and cautiously on a daily self-care measures. FIM measures 18 self-
basis using a proper assessment tool, such as care items related to eating, bathing,
the Functional Independence Measures grooming, dressing, toileting, bladder and
(FIM). bowel management, transfer, ambulation,
and stair climbing.
Determine the specific cause of each deficit Various etiological factors may need more
(e.g., visual problems, weakness, cognitive explicit interventions to enable self-care.
impairment).
Consider the patient’s need for assistive Assistive devices improve confidence in
devices. performance of ADLs.
Recognize choice for food, personal care The patient will be eager to submit himself or
items, and other things. herself to the treatment regimen that
supports his or her individual preferences.
Evaluate gag reflex or the need for Absence of gag reflex or inability to chew or
swallowing assessment by a speech therapist swallow properly may lead to choking or
prior to initial oral feeding. . aspiration
Verify the need for home health care after Shortened hospital stay have resulted in
discharge. 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.
Monitor impulsive behavior or actions This may imply the demand for
indicative of altered judgment. supplementary interventions and
management to guarantee safety or security.
Nursing Interventions
The following are the therapeutic nursing interventions for Self-Care Deficit:

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 Patient may require help in determining the
amount of dependence. safe limits of trying to be independent versus
asking for assistance when necessary.
Present positive reinforcement for all External resources of positive reinforcement
activities attempted; note partial may promote ongoing efforts. Patients often
achievements. have difficulty seeing progress.

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

Implement measures to promote An appropriate level of assistive care can

independence, but intervene when the prevent injury from activities without causing
patient cannot function. 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.
Apply regular routines, and allow adequate An established routine becomes rote and
time for the patient to complete task. requires less effort. This helps the patient
organize and carry out self-care skills.
Interventions Rationales
Feeding

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

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

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

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

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

If vision is affected, guide the patient about After a CVA, patients may have unilateral
the placement of food on the plate. neglect and may ignore half of the plate.

Provide an appropriate setting for feeding Embarrassment or fear of spilling food on self
where the patient has supportive assistance may prevent the patient’s effort to feed self.
yet is not embarrassed.
Interventions Rationales
Dressing/grooming
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 The use of buttonhook or loop-and-pile
as assessed by the nurse and occupational closures on clothes may make it possible for
therapist. a patient to continue independence in this
self-care activity.
Suggest elastic shoelaces or Velcro closures The closures eliminate tying, which
on shoes. can add to frustration.

Give frequent encouragement and aid with Assistance can reduce energy
dressing as needed. expenditure and 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 A plan that balances periods of activity with
rested before activity. periods of rest can help the patient complete
the desired activity without undue fatigue
and frustration.
Consider the use of clothing one size larger. A large size guarantees easier dressing and
comfort.
Recommend a front-opening brassiere and Clothing that is easier to put on and remove
half-slips. enhances self-care with dressing.
Transferring/Ambulation
For moderate assistance, the caregiver places This method forces the patient to maintain
arms beneath both patient’s armpits with the his or her weight forward.
caregiver’s hands on the patient’s back.
For patients needing maximal assistance, use This method maximizes patient support while
a gait belt. protecting the care provider from injury.
 Raise the bed to the tallest height
that still allows the patient’s feet to
be flat on the floor.
 Grasp the gait belt with both arms,
and pull the patient forward.
 Place a knee against the patient’s
weak knee (if applicable), and
encourage the patient to put weight
on the strong side during the transfer.
 Encourage the patient to use his or
her arms to assist, as able, and to
place them on the caregiver’s
forearms.
Aid with ambulation; direct the use of These methods promote patient safety and
ambulation devices such as canes, walkers, aid with balance and support.
and crutches.
 Stand on the patient’s weak side.
 If using a cane, place the cane in the
patient’s strong hand and ensure
proper foot-cane sequence.

Miscellaneous skills:
Telephone: Evaluate need for adaptive Patients will need a useful tool for
equipment through the therapy department communicating needs from home.
(e.g., increased volume, larger numbers, push
button phone).
Writing: Provide the patient with felt-tip Felt-tip pens mark with little pressure and are
pens. Assess the demand for a support or easier to use. Splints assist in holding the
splint on the writing hand. writing device.
Toileting

Assess and note prior and present patterns The efficacy of the bowel or bladder program
for toileting; introduce a toileting routine will be improved if the natural and personal
that factors these habits into the program. patterns of the patient are taken into
consideration.
Assess patient’s ability to verbalize Patient may have neurogenic bladder, is
necessitate to void and/or capacity to use lacking concentration, or be able to verbalize
urinal, bedpan. Bring patient to the needs in acute recovery phase, but often is
bathroom at regular or intermittent intervals able to recover independent control of this
for voiding if suitable. function as recovery develops.

Provide privacy while patient is toileting. Lack of privacy may reduce the patient’s
ability to empty bowel and bladder.
Give bedpan or put patient on toilet every 1 This eradicates incontinence. Time intervals
to 1½ hours throughout day and three times can be prolonged as the patient starts to
throughout night. verbalize the need to toilet on demand.

Give suppositories and stool softeners. May be essential at first to help in instituting
normal bowel function.
Observe closely patient for loss of balance or Patients may hurry readiness to ambulate to
fall. Maintain commode and toilet tissue the toilet or commode throughout the night
close to the bedside for nighttime utilization. due to fear of soiling themselves and may fall
in the procedure.

Keep call light within reach and teach patient This facilitates staff members to have ample
to call as prompt as possible. time to help with transfer to commode or
toilet.
Aid patient in eliminating or changing Clothing that is not easy to get in and out of
unnecessary clothing. may compromise a patient’s capability to be
continent.
Consider utilization of commode or toilet as Patients are more successful in emptying
early as possible. bowel and bladder when sitting on a
commode. A number of patients find it
unfeasible to toilet on a bedpan.
Recognize prior bowel habits and restore Supports in progression of retraining
normal regimen. Increase bulk in diet, fluid program and helps in avoiding constipation
intake, and activity. and impaction.
More Interventions

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

Inform family members to allow the patient Reinstitutes feeling of independence and
perform self-care measures as much as promotes self-esteem and improves
possible. 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
Promote independence, but intervene when A suitable level of assistive care can avoid
the patient is not able to carry out self-care harm with activities without causing
activities. disappointment.
Entertain patient input in planning schedule. Patient’s worth of life is improved when
wishes or likes are taken into consideration in
daily activities.
Consider or use energy-conservation This saves energy, decreases fatigue, and
techniques. improves patient’s capability to execute
tasks.
Other nursing diagnoses available:

 Activity Intolerance
 Acute Confusion
 Acute Pain
 Anxiety
 Caregiver Role Strain
 Chronic Pain
 Constipation
 Decreased Cardiac Output
 Deficient Fluid Volume
 Deficient Knowledge
 Diarrhea
 Disturbed Body Image
 Disturbed Thought Processes
 Excess Fluid Volume
 Fatigue
 Fear
 Hopelessness
 Hyperthermia
 Hypothermia
 Imbalanced Nutrition: Less Than Body Requirements
 Imbalanced Nutrition: More Than Body Requirements
 Impaired Gas Exchange
 Impaired Oral Mucous Membrane
 Impaired Physical Mobility
 Impaired Swallowing
 Impaired Tissue (Skin) Integrity
 Impaired Urinary Elimination
- Functional Urinary Incontinence
- Stress Urinary Incontinence
- Reflex Urinary Incontinence
- Urge Urinary Incontinence
 Impaired Verbal Communication
 Ineffective Airway Clearance
 Ineffective Breathing Pattern
 Ineffective Coping
 Ineffective Tissue Perfusion
 Ineffective Therapeutic Regimen Management
 Latex Allergy Response
 Powerlessness
 Rape Trauma Syndrome
 Risk for Aspiration
 Risk for Bleeding
 Risk for Falls
 Risk for Infection
 Risk for Injury
 Risk for Unstable Blood Glucose Level