Discuss or do an explanation of your evaluation plan for the patient in the case study you selected and explain which type of assessment tool you might use for the patient.

As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as the advanced practice nurse, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of geriatric patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability. For this Discussion, consider which assessment tools would be appropriate for the patients in the following three case studies:

Case Study 1:

Mr. Smith, age 77, 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.

Case Study 2:

Mr. Jones, a 68-year-old man, was referred to your office for a hearing evaluation. He continues to work in a printing company, although he works only part-time. He has worked at the printing company for the past 35 years. He complains that he cannot hear much of the dialogue on the television. He is accompanied by his wife, who states that her husband cannot hear her at home. He has no history of dizziness, tinnitus, or vertigo. He has had cerumen impactions removed from both ears in the past. Overall, his medical history is quite benign. His only medications are aspirin 81 mg daily, a multivitamin daily, and occasional ibuprofen for back pain.

Case Study 3:

Mrs. Roberts, an 83-year-old widow, is brought to the office by her daughter. The daughter claims that her mother seems to be depressed. There is a history of depression approximately 5 years ago, shortly after Mrs. Roberts’ husband died. At that time, she was successfully treated with antidepressants. Currently the daughter states that her mother’s memory for appointments and events has declined severely, and she can no longer drive because she does not remember the route to the store or other familiar places. The daughter also noted that her mother’s house seemed very disorganized and dirty, there was a limited amount of food in the kitchen, and the checkbook had not been balanced for several months. Mrs. Roberts appears slightly disheveled, she has a flat affect, and she does not maintain eye contact during your interview.

To prepare:

Review the Rosen and Reuben article in this week’s Learning Resources.

Consider how assessment tools are used to evaluate patients.

Select one of the three case studies.

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.

Discuss or do an explanation of your evaluation plan for the patient in the case study you selected and explain which type of assessment tool you might use for the patient.

Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments such as language, education, prosthetics, missing limbs, etc.

RESOURCES:

Readings:

Flaherty, E., & Resnick, B. (Eds.). (2011). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (3rd ed.). New York, NY: American Geriatrics Society.
Chapter 6, “Assessment” (pp. 43–48)

This chapter reviews essential components of the comprehensive geriatric assessment including physical, cognitive, psychologic, and social assessment. It also emphasizes other areas of importance such as assessing quality of life and driving concerns.
Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing Ltd.
Chapter 1, “Function and frailty: the cornerstones of geriatric assessment” (pp. 1–12)

This chapter describes frailty and provides guidelines for assessing frailty in older adults. It also examines functional impairment in older adults and identifies functional assessment tools for treating and preventing functional decline in frail older adults.
Rosen, S., & Reuben, D. (2011). Geriatric assessment tools. The Mount Sinai Journal of Medicine, New York, 78(4), 489–497.
Retrieved from the Walden Library databases.

This article identifies common conditions that impact elderly patients. It also presents assessment tools that screen for geriatric syndromes such as hearing impairment, vision impairment, functional decline, falls, urinary incontinence, cognitive impairment, depression, and malnutrition.

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