Health Assessment of an Elderly Patient - Assignment Example

Health Assessment Activity 2 2 MR. G is a 64 years old Hispanic male who reports pain and numbness in her knees, ankle joints, elbows, and wrists. Mr. G is overweight with BP 160/80 and a regular HR of 96. He has a respiratory rate of 24 with no fever. He also has a history of acute arthritis. He has experienced a decrease in his functional ability as he reports that he no longer goes for walks like he initially did, and that he no longer volunteers in the kindergarten as a cook. 2.2 Peter believes that he is just experiencing symptoms of old age and that everyone experiences them at some point. From my review, it is evident that Mr. G’s condition with arthritis is advancing to a more chronic stage as he reports most of his activities around the joints having rapidly reduced. Activity 3 3.1 The subjective data is important in revealing the experiences of the patient from a firsthand account. On the other hand, objective data is important in determining the clinical status of the patient through examination and tests. 3.2 During the collection of information, confidentiality and information safety is upheld. Upon assuring the patient that their information may be kept private, they can disclose some of the private information related to their condition. In addition, I do not engage in any further research concerning the patient without their consent in order to limit any chances of intrusion into their private information. 3.3 Some of the patient assessment tools that bare within nurses, which are applied in assessing morbidity of the patients. These tools include the decision-making tools, which provide guidelines on the main approach to determining the morbidity of the patients including ruling out of some of the cases in relation to both the subjective and objective data of the patient. Nurses also carry within them education tools that allow them to consider the best technology for assessing patients at each level. Communication tools are also important in creating a rapport with the patient and thus establishing a proper assessment of the morbidity levels. 3.4 Inspection involves application of vision, hearing, and smell to assess abnormal deviations and conditions within the body of a patient. An example of inspection is the observation for yellow eyes in an individual with jaundice. Palpation involves touching of the patient’s area of body under examination with varying parts of one’s hands, while employing different degrees of pressure. This can be employed when checking for cancerous lumps in the breast. In addition, Percussion requires one to tap their hands or fingers against given parts of the patient’s body in a sharp and quick motion, in order to determine any abnormalities in terms of the position or shape of an organ, or if it is filed with gas or water. This can be used to check for edema in internal organs such as the lungs. Lastly, auscultation is a technique that involves listening to sounds within the lungs, bowel, or heart using a stethoscope. This can be used to check for an individual’s heart rate and relate it to the normal range. Activity 4 4.1 All members of the health care team assess the needs of the patient in relation to their expertise and properly communicate through patient notes that are left by the bedside in order to allow for a collaborative approach towards handling the patient. As a nurse, my role in the team is to reinforce what the other members of the team such as the physicians say about the patient, including the treatment plan. This is achieved by educating the patients and appropriately answering their follow-up questions and those of their families or friends. As a nurse, it is also important to understand the role of all the other health care team members and to integrate their roles into one holistic system that can be implemented to ensure patient well-being. Activity 5 5.1 Age changes reduce the skin’s ability to perform its functions in older people, besides the ability of identifying any abnormalities within the skin. It is important to note that the health of the skin is important for general well-being among older people. As such, it is important to ensure skin assessment and skin care regimes are implemented at individual level in order to ensure that older people have skin and dry skins. 5.2 The Skin Integrity Risk Assessment Tool developed by White M. W., Karam S., and Cowell B. in 1994 is an effective tool for skin integrity assessment among the older people. The tool involves three groups of questions, with Group I comprising of one item, Group II eight items, and Group III fifteen items, all of which an older person is required to respond to in order to assess their need for a risk reduction program. 5.3 Poor skin turgor is a case where there is a delay in skin recoil after a pinch for a given amount of time due to dehydration. However, dehydration may not be the cause in older people due to wrinkling. As such, in order to check for dehydration and poor skin turgor in the older people, it is important to consider sites on their bodies, that are least affected by wrinkling. These include the areas below the clavicle, over the sternum, between the eyebrows in the forehead, or on the inner side of thighs. Activity 6 6.1 Signs of dysphagia in older patients include inability to swallow, pain when swallowing, choking, gagging, or coughing when swallowing, regurgitation, feeling like food is stuck in the throat or chest, heartburn or chest pressure, an increased weight loss. 6.2 Dysphagia management options include exercising swallowing muscles, change in diet, dilation, endoscopy, surgery, or other medicines if it is related to other conditions. Activity 7 7.1 The nutrition status of the older persons can be altered by inadequate dietary intake of some nutrients due to a poor diet or interference with nutrients by health conditions either through reduction of appetite or increased tissue catabolism. Nutrition screening should include a review of the patient’s diet and any underlying health conditions. 7.2 The BMI tends to give a better picture of my health status, one that cannot be easily determined by simply viewing myself in the mirror. 7.3 As much as appearance may be helpful in classifying the nutritional status of an individual, it may not always be a conclusive tool in defining the nutrition status of an individual. In some cases, the health condition or age of an individual may be a related factor in their general appearance. For instance, a wrinkled and dry skin in older people may not always mean that they dehydrated and deficient of Vitamin E. this may only be a consequence of aging. 7.4 Anthropometric measurements are measures used in assessing the body fat of an individual in relation to different parts of the person’s body. Due to the changes that accompany aging, these tools have proven to be less accurate for the older people and thus should be combined with clinical tests. 7.5 Among others, conditions such as dysphagia, HIV/AIDS, Cancer, and other pain-inducing conditions affect appetite among older people. Other aspects related to ageing such as declined immunity and increased risk of infection, reduced smell and taste altering appetite, dry mouth, tooth loss, and reduced gastrointestinal function leading to impaired absorption all inhibit nutrient intake. Activity 8 The height of bedridden patients can be estimated using three methods including the knee height, demi-span, and forearm length. The knee height is measured by allowing the patient to lie supine and then holding the ankle and the knee at 90 degrees before using a sliding broad-board caliper to measure the knee height. This is then used to calculate the height using the formulae below: Male height (cm) = 64.19 – (0.04 × age) + (2.02 × Knee height) Female height (cm) = 84.88 – (0.24 × age) + (1.83 ×knee height) The forearm length is determined by measuring the ulna length, which is the length between the midpoint of the wrist’s prominent bone and the point of the elbow. Using the length, a chart is used to estimate the height of the person. The demi-span involves measurement of the distance between the center of the sternal notch and middle finger’s tip in the coral plane. Height is calculated using the formulae below: Male height (cm) = (1.40 × demi-span (cm)) + 57.8 Female height (cm) = (1.35 × demi-span (cm)) + 60.1 8.1 Various pathological and physiological changes including organ system changes, molecular changes, altered compensation to stressors, and systemic changes may occur among older adults and affect vital signs. These changes and comorbidities in individual patients reduce the sensitivity of single-point vital signs’ measurements in observing disease processes. However, the sensitivity of the assessment of serial vital signs may be increased if individualized reference ranges are used as the context of view. 8.2 The Canadian Neurological Scale is underutilized at my workplace. As much as most of the nurses engage in patient reviews with the aid of this tool, most of the reviews only consider one category of functions such as the mentation category and base their judgment on the patient’s neurological status on it without considering the other categories such as the motor functions. In addition, most of the patients that are brought in while unconscious are not taken through such reviews. There is no consistency in the documentation of such reviews and thus it is difficult to trace the trail of investigation when required. As much as there is awareness among the nurses concerning Best Practice Guidelines (BPGs), more time is required for the translation of the changes into practice and at times BPG modification may be required in order to suit the needs of the areas of application. In order to proper neurological assessment, it is important to consider switching to a tool that would be consistently used in the neurological assessments, especially in acute phases. In addition, it is important to develop a good SOP for development in the workplace, which should be shared and agreed upon [prior to its implementation to allow for a uniform approach to documentation. 8.3 Delirium is caused by a combination of various factors that increase the vulnerability of the brain and initiate brain activity malfunction. These factors include old age, dementia, visual or hearing impairment, dehydration or poor nutrition, terminal or chronic illnesses, multiple medical problems, drug abuse or alcohol or withdrawal, and treatment involving multiple drugs. Activity 9 9.1 Visual and hearing impairment in older adults can be associated with various causative factors including exposure of these individuals to oxidative stress, atherosclerosis that leads to muscular degeneration, cigarette smoking, and diabetes. Some of the functional abilities affected by hearing and vision loss include movement, communication, and other daily activities. Activity 10 10.1 One of the major pain assessment tools among older adults is the Pain Assessment in Advanced Dementia (PAINAD) Scale. This tool is effective as it allows for the assessment of pain without relying on communication as older adults in pain are unable to communicate their pain. However, this tool may fail to categorize pain as either chronic or acute. 10.2 Individuals with decreased cognitive function are not able to report pain. As such, the most effective way to handle such cases is through carrying out a functional and psychosocial assessment. There is an established association between depressed mood and pain among older adults. 10.3 Analgesic Patch technology allow for easier administration of pain medication and management of chronic pain among the elderly. This technology has an additional benefit among the older adults by decreasing the risk of development of adverse events (AEs) that is normally associated with other pain medication among older adults. Activity 11 11.1 An individual given anticoagulants, antibiotics, and cardiovascular medication classes of drugs on a polypharmacy regime experienced Adverse Drug Events (ADEs) which called for the change of the drugs to deter such adverse events while still maintaining management of the illnesses. Various issues may result in the need to change medication including cognitive impairment, nutrition, falls, urinary inconsistency, functional status, and non-adherence to medication. 11.2 Physical barriers to compliance with self-medication among older adults includes physical disability as a result of reduced sensation, strength, or vision. In addition, psychological barriers such as emotional distress and major depression may inhibit self-care. Other factors include the socioeconomic status of the patient, one’s awareness of the chronic condition, family support and health literacy. The role of the patient is to educate the patient and their family on the health condition and the importance of self-care. Activity 12 12.1 Person-centered care is the care and treatment provided by health providers to older adults, while allowing them to participate in the care process with a primary focus on the needs of the patient. This can be achieved by allowing the patient to express their needs, participate in decision-making, appoint a substitute decision maker, offering treatment that accords with the goals, values, and beliefs of the patient. 12.2 The development of level 1 beds to handle organ-specific illnesses among older adults is a demanding process of medical staffing including the nurses. This requires pooling of expert staff and resources, and thus expensive for most hospitals. 12.3 Awareness of dementia among older adults is important in the care of such adults. This would allow for the appropriate assessment of their progress and determination of the most effective way of managing their conditions. 12.4 Potential risk of hospitalized older adults include under treatment of pain, non-compliance with medication, and experiencing adverse events as a result of combined drug therapy. This can be managed by using other methods of pain assessment, educating the patients, and changing the drugs to reduce the adverse events. Activity 13 13.1 Advanced care planning involves a series of steps that can be taken by the patient to allow them to effectively plan for their future healthcare. This is important in determining what is important to the patient and incorporating it into their care. Activity 14 14.1 The ACAS has a role to determine the entire care needs of older people that are frail and to offer them assistance in gaining access to the types of services that are most appropriate to the client. Read More