Question

III. Case Study : Functional Assessment in the Elderly

Patient Profile

H.J., a 74-year-old African American male, is a retired army military officer. His wife of over 50 years passed away four years ago. He has four daughters and two sons who are all grown and married. He has fourteen grandchildren with a great-grandchild on the way. His son brought him to the health care provider today because he is concerned his father has been more forgetful and is losing weight. H.J. has a history of coronary artery disease that is being managed with metoprolol XL (Lopressor) and aspirin.

Subjective Data

Patient states, "I am doing fine. I just miss my wife and the fine meals she used to make.”

His son says he has noticed his dad has been tightening his belt up to two notches.

Patient states, "My children are worrying unnecessarily."

What level of assessment do you need to perform?

How will your assessment be different from the assessment performed by the health care provider?

Case Study Progress

Objective Data

Physical Examination

Blood pressure 136/80, pulse 62, respiratory rate 16, temperature 97.6° F

Height 5'10", weight 158 lb, BMI 22.7

Neurological: Alert and oriented to person, place, and time. Pupils equal and reactive to light, grips equal strength.

Respiratory: Lung sounds clear in all fields.

Cardiovascular: Heart sounds regular in rate and rhythm; S1 and S2 heard; no murmurs auscultated. Radial pulse and pedal pulses present.

Gastrointestinal/Nutrition: Bowel sounds present and active in all four quadrants. Abdomen soft and nondistended, nontender.

Skin: Pink, warm,and dry; skin turgor good, no tenting, cap refill < 2 seconds; no skin breakdown on bony prominences. Has healing abrasions noted on both knees.

GU/Elimination: Per patient, his last bowel movement was early in the morning. He goes every 2-3 days and describes his stools as medium-size and brown. States he is urinating without difficulty.

Musculoskeletal: States he is able to walk around the block without difficulty; his son says that the knees are scraped from a recent fall.3. Based on your assessment, you are concerned about H.J.’s functional abilities and decide to evaluate him further. What types of functional screening tools would be appropriate for H.J.?

4. What is the difference between activities of daily living and instrumental activities of daily living ?

Case Study Progress H.J. is able to complete the "time to get up and go" test in 22 seconds. His performance on the Mini-Cog does not reveal any potential deficits; when asked if he feels sad or depressed, he states that he does not.

5. What nursing diagnoses and problems do you feel exist for H.J ?

Answer 1

The level of assessment I will perform for the Weight loss of Mr. H.J will be Cognitive Assesment various Tests that can be done to rule out Cognition and Depression are -

• Mini-Cog
• Mini-Mental State Examination (MMSE)
• Score
• 3-item recall at one minute
• Serial 7’s -
• Clock Drawing Test

This is Different from what is done by physician as -

Geriatric Depression Scale (GDS) is a 15-item questionnaire that can be completed in writing or during an interview. Thus, while it is too long for non-primary care clinicians to administer in the office, it may be feasible to administer to high-risk patients in writing before or after a visit.

3. Based on my Assesment -I will Evaluate Mr.HJ for Gait Instabilities and Falls As his Son mentioned that he had some knee scrapping due to Some Recent fall.

I will do time to get and go Test

Normal time required to complete test: less than 10 seconds. Further evaluation required if test not performed in 20 seconds. Patients who require more than 20 seconds for this test have limited physical mobility, may be at risk for falls and may require assistance from others for many mobility tasks including basic transfers.

So Mr. HJ must have some Recent Fall as He Is able to complete this Test in >20sec.

4.

Activities of daily Living	Instrumental activities of daily living
Bathing	Grocery shooping
Dressing	Driving and Transportation
Toileting	Preparing the Meals
Transfers	Housekeeping
Grooming	Laundary
Feeding	Handling Own Finances

5. Nursing Diagnosis is Maybe the Patient has become little weak Due to ageing process and maybe he has got some Ageing disease Such Osteoporosis Which Furthur need to be dealt with. The problem I feel for Mr. HJ was he got negative At time to go and get test which is surely due to his ageing Osteoporosis which made his bone little weak as compared the other people.