Fulmer Spices Questionnaire

Topics: Sleep, Urinary incontinence, Somnolence Pages: 2 (380 words) Published: January 9, 2013
Fulmer SPICES Questionnaire
Sleeping Problems
1. Do you have any problems sleeping?
Only if I am having heart burn. Not usually though.
2. Do you know what makes it difficult for you to sleep?
I can’t sleep with loud noises or bright lights.
3. How many hours a night do you sleep?
Anywhere from 8-10 hours.
Problems with Eating and Feeding
1. Do you have a problem cutting up food or using utensils?
I have occasional problems cutting meat.
2. Do you have any pain when you swallow?
3. Do you prefer food with a softer consistency?
Yes, it is easier to chew with dentures.
4. Do you have dentures?
Yes, a full set of dentures.
1. Do you have control over your bladder and bowels?
I have very little control over bladder.
2. How often do you urinate?
Every 2-3 hours and sometimes once during the night.
3. When you have the urge to urinate, do you have to go right away or do you have time to get up and go? I have very little time between the urge coming and going to the bathroom. Do you think I wear briefs for fun? (Laughs) Confusion

Do you ever feel confused?
Sometimes in the middle of the night when I get up to use the washroom. What causes this confusion?
I think being half awake and tired.
Evidence of Falls
1. Have you ever fallen?
2. When was your last fall?
A few weeks ago, when I was washing my hands in my bathroom. My roommate had to get help for me. (After interview, I confirm with RN that residents last fall was January 17, 2012) 3. Do you use assistive devices to ambulate?

Yes, a walker and a wheel chair.
4. How many people do you require to get out of bed and get ready for the day? One other person.
Skin Breakdown
1. Do you have problems with your skin?
I have an ulcer on my leg that keeps popping up. (Points to right lower leg) 2. Do you use any lotions?
No, I prefer powders to lotion.
3. Do you have skin sensitivity, like bruising or dryness?
I bruise easily. (Shows me bruise on upper chest from...
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