NRNP 6540 Week 1: Assessment of Older Adults
You will choose only ONE of the case studies below to respond to:
Please refer to your required readings and media. These are the best sources to use as APA citations and references. Yes these are required in all of your writings! (See the note in doc sharing for more information on APA format)
Case Study 1:
Mr. Perkins, age 81, reports for an annual physical examination. He says he is doing well. His only known problem is osteoarthritis. He also requests a flu shot. He takes no medications other than Tylenol for arthritis pain. When he walks into the exam room, you notice that he is using a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months.
THEN: Review the case study and based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments such as language, education, prosthetics, missing limbs, etc.
Consider immunization requirements that may be needed for this patient.
Keep in mind that as nurse practitioners, whether you are primary care or acute care, patient and family education is always important. This includes education about medications, tests, treatment plans, immunizations, diagnosis, and health promotion.
PLEASE COVER ALL POINTS IN YOUR DISCUSSION. POINTS WILL BE DEDUCTED IF ALL POINTS ARE NOT ADDRESSED! I recommend that you write your discussion in a word document on your computer, spell and grammar check, save it, and then copy and paste into BB. Always review the rubric in BB.
REMEMBER TO CITE AND REFERENCE IN APA 7TH EDITION WHERE NEEDED. I also recommend that you cite your sources from the readings from your required and recommended reading lists!
BY DAY 6:
Respond to at least two of your colleagues on two different days in one or more of the following ways: – put this on your calendar reminders or post on your computer as a reminder. You cannot receive a grade if you do not respond to two classmates.
Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues patients.
Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.
Explain other health promotion considerations for patients in this population or with related issues.
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Case Overview
The case involves an 81 year old, Mr. Perkin, who presented for an annual physical examination. He is progressing well and has osteoarthritis. During this visit, he requests for a flu shot. Mr. Perkin’s takes no other drugs apart from Tylenol for arthritis pain. As Mr. Perkin’s walks into the examination room, you notice that he is using a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months.
Osteoarthritis (OA) is a degenerative joint disease that often affects the knee joint and is characterized by progressive tear and wear and loss of articular cartilage. It is a common diagnosis in the elderly population and in severe cases, can result in permanent disability. The prevalence of OA is higher in males compared to females. Among people aged 70 years and older, OA has a prevalence that is as high as 40% and in those aged 60 years and older with symptomatic disease, the prevalence in males and females is 10% and 13% respectively (Chen et al., 2017). A critical evaluation of Mr. Perkins demonstrates that apart from the OA-associated pain, the disease is negatively impacting his mobility. Chen et al., (2017) demonstrates that among elderly patients diagnosed with OA, decreased mobility and pain increase the risk of falls and fall-related injuries, ability to independently perform and instrumental activities of daily living (IADLs) as well as activities of daily living (ADLs). Ultimately, patients will experience a poor quality of life (QOL).
It will be important to perform a comprehensive geriatric assessment (CGA) on Mr. Perkins as the findings can help in identifying individual healthcare needs and potential gaps in care. The nurse will use the findings of the CGA to develop a personalized plan of care for optimal and patient-centric outcomes. According to Ball et al. (2019), the CGA must include the following components; psychological, physical, socio-environmental, functional, and QoL. Considering her age and underlying diagnosis, she is at a high risk of other chronic illnesses such as cancers that can also result in pain. Therefore, while conducting a comprehensive physical examination, the nurse should evaluate whether Mr. Perkin’s pain is as a result of the OA diagnosis or other chronic underlying causes. Her comprehensive laboratory evaluation should assess for
- glycemic control,
- Urea Electrolytes and Creatinine (UECs)
- Underlying anemia,
- Renal function test
- Liver function test (metabolism)
- Iron, folate, and vitamin B12 deficiencies
Considering Mr. Perkin’s advanced age and comorbid OA, she is at a high risk of sustaining a fall. Therefore, it is mandatory to conduct a fall risk assessment. One of the most currently recommended and reliable tool to conduct this assessment is the Hendrich II Fall risk Model after which, the nurse can recommended practical fall prevention measures to decrease her overall fall risk Scale (Ball et al., 2019). Besides, her current status predisposes her to a high risk of geriatric depression, which has a high morbidity and mortality. A valid and reliable tool to evaluate for geriatric depression for Mr. Perkin is the Short Form Geriatric Depression Scale (Ball et al., 2019). His evaluation should be conducted from the comfort of her home, preferably in liaison with a home health agency. During the assessment, the nurse should evaluate the patient’s support system (family) and related dynamics.
He needs to be educated about the immunization recommendations for older adults which particularly the flu vaccine and pneumococcal vaccine (Coll et al., 2019). The care plan should prioritize adequate control of pain through dosage, drug and frequency modifications until there is adequate control. Mr. Perkin will also need the intervention of an occupational and physical therapist to regain physical and functional control.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby
Chen, D., Shen, J., Zhao, W., Wang, T., Han, L., Hamilton, J. L., & Im, H. J. (2017). Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone research, 5, 16044. https://doi.org/10.1038/boneres.2016.44
Coll, P.P., Costello, V. W., Kuchel, G. A., Bartley, J., & McElhaney, J. E. (2019). The prevention of infections in older adults: Vaccination. Journal of the American Geriatrics Society, 68(1), 207-214.
