NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults Essay

NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults Essay

NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults Essay

It is good that you have started the discussion by noting the major details about the patient. The patient is male and is old since he is 81 years old. Following his medical history, the patient has been suffering from osteoarthritis; hence, he has been taking Tylenol for the arthritis pain. The patient requested a flu shot. However, you should have enquired why they requested the flu shot to determine if they have other underlying issues that they might not know of. The pain has increased since the patient is using a cane, and something more must be done to eliminate the consistent pain. According to Göhner et al. (2023), older patients are at risk of medical complications, including medication side effects. Following this, it is important to review the patient fully to determine if the medication should be changed and what should be done to manage his hip pain.

            I agree with you that as geriatric patients age, their risk for multiple morbidities and functional decline increases; therefore, clinicians must be able to distinguish between typical or expected changes and the presence of an illness in such patients. According to Göhner et al. (2023), since older patients are at increased risk of delirium and inappropriate prescribing, these risk factors can accumulate, promoting a degree of morbidity and the development of cognitive impairment. It is crucial to conduct further tests to determine why the patient’s health deteriorates. The healthcare practitioner should ensure that they gather all details from the patient so that all tests can be done to determine what is wrong if the healthcare practitioner and the patient have good relations. The chances of better healthcare outcomes are high.

Considering that the hip joint pain is worsening to the extent that the patient is using a walking stick, it is important to perform a multidimensional approach such as a Comprehensive Geriatric Assessment (CGA). Comprehensive Geriatric Assessment (CGA) is a multidimensional process that is designed to assess the functional ability, health (physical, mental, and cognitive), and environmental situation of older people (Garrard et al., 2019). It is good that you have also included that the tool will be used to evaluate the patient’s physical health (history taking, nutritional assessment, physical examination, diagnostic, and medication review), functional health (gait and balance, activities of daily living, and hearing and vision assessments), psychological health (cognitive disorders such as dementia and delirium, depression, and spiritual well-being), socio-environmental supports (such as living situation, economic resources, support system, and environmental safety), and quality of life measures (Nord et al., 2021).

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It is important to ask the patient if he had fallen to rule out hip fractures. Therefore, the healthcare practitioner must conduct a CT scan to determine if there are any fractures. Older patients have a high chance of suffering from dementia; therefore, they might not remember if they had fallen. According to Weber et al. (2019), there is a high relationship between osteoarthritis and the risk of dementia. As a result, it is crucial to evaluate the progression of the patient’s arthritis and other possible causes that may have contributed to his increased hip pain and declined mobility. I like the tools you listed that can be used to determine the level and severity of the risks involved. Although all the tools are important, the Katz Index of Independence in Activities of Daily Living is more important since it will assess the patient’s functional status and ability to perform daily activities independently (Liebzeit et al., 2018). Generally, your discussion is great since you have explained how you will assess the patient to give a proper diagnosis and medication.

References

Garrard, J. W., Cox, N. J., Dodds, R. M., Roberts, H. C., & Sayer, A. A. (2019). Comprehensive Geriatric Assessment in Primary Care: A Systematic Review. Aging Clinical and Experimental Research, 32(2), 197–205. https://doi.org/10.1007/s40520-019-01183-w

Göhner, A., Dreher, E., Kentischer, F., Maurer, C., Farin-Glattacker, E., Von der Warth, R., Brühmann, B. A., Maun, A., Minin, V., Salm, C., Ritzi, A., Engelhardt, G., Sofroniou, M., & Voigt-Radloff, S. (2023). Correction: Reduction of Care-Relevant Risks to Older Patients during and after Acute Hospital Care (ReduRisk) – Study Protocol of a Cluster Randomized Efficacy Trial in a Stepped Wedge Design. BMC Geriatrics, 23(1). https://doi.org/10.1186/s12877-022-03580-9

Liebzeit, D., King, B., & Bratzke, L. (2018). Measurement of Function in Older Adults Transitioning from Hospital to Home: An Integrative Review. Geriatric Nursing, 39(3), 336-343. https://doi.org/10.1016/j.gerinurse.2017.11.003

Nord, M., Lyth, J., Alwin, J., & Marcusson, J. (2021). Costs and Effects of Comprehensive Geriatric Assessment in Primary Care for Older Adults with High Risk for Hospitalisation. BMC Geriatrics, 21(1). https://doi.org/10.1186/s12877-021-02166-1

Weber, A., Mak, S. H., Berenbaum, F., Sellam, J., Zheng, Y., Han, Y., & Wen, C. (2019). Association Between Osteoarthritis and Increased Risk of Dementia. Medicine, 98(10), e14355. https://doi.org/10.1097/md.0000000000014355

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Case Study:

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.

As geriatric patients age, their risk for multiple morbidities and functional decline increases; therefore, clinicians must be able to distinguish between typical or expected changes and the presence of an illness in such patients (Kennedy-Malone & Groenke-Duffy, 2023). Considering the patient’s age, health history of osteoarthritis, worsening right hip pain symptoms (in the last six months), and the fact that he is coming in for an annual physical are indicators that a multidimensional approach such as a Comprehensive Geriatric Assessment (CGA) should be performed. CGA is an interprofessional and multifaceted process that identifies patients’ care needs and treatment plans, leading to improved health outcomes (Kennedy-Malone & Groenke-Duffy, 2023). Additionally, the CGA will evaluate the above patient’s physical health (history taking, nutritional assessment, physical examination, diagnostic, and medication review), functional health (gait and balance, activities of daily living, and hearing and vision assessments), psychological health (cognitive disorders such as dementia and delirium, depression, and spiritual well-being), socioenvironmental supports (such as living situation, economic resources, support system, and environmental safety), and quality of life measures (such as care preference and physical, social, and environmental conditions) (Kennedy-Malone & Groenke-Duffy, 2023).

The above-mentioned multidimensional approach will allow the primary care provider (PCP) to gain a better understanding of the patient’s current health status, identify the level of risk involved for the physical, functional, and psychiatric decline, and ultimately help in choosing the best treatment in collaboration with the patient and other multidisciplinary teams such as a radiologist, physical therapist, occupational therapist, home health nursing, and potentially a psychiatrist.

Due to the patient’s age, history of osteoarthritis, and reported worsened right hip pain, it is vital to rule out possible hip fractures, malignancies, or the degree of bone damage. Therefore, besides obtaining a thorough CGA, an X-ray and (based on X-ray results) a CT scan should be ordered. Also, as the patient already has a few risk factors, such as age, osteoarthritis, and weakness (due to using a cane and increased pain), his fall risk increases. According to Nemati et al. (2023), one of the leading causes of disability is knee arthritis, which can also lead to one’s falls. Additionally, studies have shown a correlation between osteoarthritis and the risk of dementia (Weber et al., 2019). Therefore, it is crucial to evaluate the progression of the patient’s arthritis and other possible causes that may have contributed to his increased hip pain and declined mobility. Furthermore, knowing that the above patient is at increased risk for falls and dementia development, the following tools might need to be utilized to determine the level and severity of the risks involved:

Katz Index of Independence in Activities of Daily Living (ADL)- is a tool that assesses one’s functional status and ability to perform activities of daily living independently (ADL) (HIGN, 2020).

Timed Get Up and Go Test- will assess the patient’s mobility and balance (Kennedy-Malone & Groenke-Duffy, 2023).

Fall Risk Assessment for Older Adults: The Hendrich II Fall Risk Model- can predict the patient’s falls by identifying eight fall risk factors. Additionally, it can determine the cause of the fall risk. Finally, it can be integrated in the electronic health record (EHR) (HIGN, 2020).

PHQ-9 evaluates the presence of depression and functional impairment.

MMSE is a quick assessment tool that can help evaluate the patient’s cognitive function (Kennedy-Malone & Groenke-Duffy, 2023).

Although the above-mentioned assessment tools are validated for use with this patient population, it would also be beneficial to assess the patient’s home environment for safety, as an unsafe home environment (with uneven surfaces, lack of hand railing, and poor lighting) can also contribute to his falls (Kennedy-Malone & Groenke-Duffy, 2023).

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Excessive pain, possible impaired mentation, possible malnutrition or obesity, and possible low literacy might present issues when assessing the patient. Therefore, ensuring that his pain is well controlled with Nonsteroidal Anti-inflammatory Drugs (NSAIDs) is vital, as these are the first-line treatment for osteoarthritic pain (Nowaczyk et al., 2022). Also, if the patient’s mental status has worsened, ensuring his family is present during the assessment might be beneficial. Finally, educating the patient and family about a balanced diet and exercise ensures proper nutrition and muscle and bone strength (Kennedy-Malone & Groenke-Duffy, 2023).

Immunization requirements related to health promotion and disease prevention for this patient are the following: influenza vaccine annually, COVID-19, 2-3 doses of primary series and booster, Hep A and B series, Tdap booster every ten years, varicella: two doses, zoster: two doses, and pneumococcal: 1 dose PCV15 OR 1 dose PCV20. If PCV15 was given, it should be followed by a dose of PPSV23 given at least one year after the PCV15 dose (CDC, 2020).

References

Centers for Disease Control and Prevention. (2020). Recommended adult immunization schedule for ages 19 years or older.

https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdfLinks to an external site.

Hartford Institute for Geriatric Nursing (HIGN). (2020). General Assessment Series. In Try This: Series. Author. https://hign.org/consultgeri/try-Links to an external site.

this/general-assessmentLinks to an external site.

Kennedy-Malone, L., & Groenke-Duffy, E. (2023). In Advanced practice nursing in the care of older adults (3rd ed). F.A. Davis.

Nemati, D., Keith, N., & Kaushal, N. (2023). Investigating the Relationship Between Physical Activity Disparities and Health-Related Quality of Life

Among Black People With Knee Osteoarthritis. Preventing chronic disease, 20, E56. https://doi.org/10.5888/pcd20.220382Links to an external site.

Nowaczyk, A., Szwedowski, D., Dallo, I., & Nowaczyk, J. (2022). Overview of First-Line and Second-Line Pharmacotherapies for Osteoarthritis with

Special Focus on Intra-Articular Treatment. International journal of molecular sciences, 23(3), 1566. https://doi.org/10.3390/ijms23031566

Weber, A., Mak, S. H., Berenbaum, F., Sellam, J., Zheng, Y. P., Han, Y., & Wen, C. (2019). Association between osteoarthritis and increased risk of

dementia: A systemic review and meta-analysis. Medicine, 98(10), e14355. https://doi.org/10.1097/MD.0000000000014355