Question

I. Read Chapters 1 to 3 from your Textbook.

II. NCLEX Review Questions Chapters 1 to 3

III. Chapter 3 : 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?

5. You decide to use the Mini-Cog to evaluate if H.J. has a neurocognitive disorder. Describe the administration and interpretation of the Mini-Cog.

6. Falls are associated with subsequent decline in functional status. Describe how to use the "time to get up and go" test to screen H.J. for gait instability and risk of falls.

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

Answer 1

Solution

1. Functional assessment is a continuous collaborative process that combines observing, asking meaningful questions, listening to family stories, and analyzing individual child skills and behaviors within naturally occurring everyday routines and activities across multiple situations and settings

2. The geriatric functional assessment differs from a typical medical evaluation by including nonmedical domains; by emphasizing functional capacity and quality of life; and, often, by incorporating a multidisciplinary team including a physician, nutritionist, social worker, and physical and occupational therapists. This type of assessment often yields a more complete and relevant list of medical problems, functional problems, and psychosocial issues.

4. ADLs (Activities of Daily Living) are basic self-care tasks. The six basic ADLs are eating, bathing, dressing, toileting, mobility, and grooming. Eating includes feeding oneself and getting all the vitamins and nutrients needed to stay healthy. Bathing includes cleaning one’s body and the ability to get in and out of the tub or shower safely. Dressing oneself means not only physically putting on clothes, but also choosing the appropriate attire for the weather. Toileting is both using the toilet independently and also recognizing the urge to use the restroom. Mobility envelops walking, transferring (moving from the bed to a wheelchair), and climbing up or downstairs, if necessary. Grooming is brushing teeth, combing hair, and maintaining personal hygiene.

IADLs (Instrumental Activities of Daily Living) are slightly more complex skills. They include managing finances, handling transportation, shopping, preparing meals, using the telephone or other communication devices, managing medications, doing laundry, housework, and basic home maintenance. Difficulty managing these tasks are common in patients with early stages of dementia.

5. The Mini-Cog; is a 3-minute instrument that can increase the detection of cognitive impairment in older adults. It can be used effectively after a brief training in both healthcare and community settings. It consists of two components, a 3-item recall test for memory and a simply scored clock drawing test.

What is the Mini-Cog test used for?

The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings. Objectives: To determine the diagnostic accuracy of the Mini-Cog for diagnosing Alzheimer's disease dementia and related dementias in a primary care setting

How is the mini cog test scored?

To obtain the mini-cog score, add the recall and CDT(Clock Drawing Test) scores. 0-2 indicates a positive screen for dementia. 3-5 indicates a negative screen for dementia.

Administering the Mini-Cog

1. Make sure you have the patient's attention. ...
2. Ask the patient to repeat the words to ensure understanding. ...
3. Ask the patient to draw a clock. ...
4. Ask the patient to recall the 3 words.

6. The Timed Up and Go test (TUG) is a simple test used to assess a person's mobility and requires both static and dynamic balance. It uses the time that a person takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down. During the test, the person is expected to wear their regular footwear and use any mobility aids that they would normally require. The TUG is used frequently in the elderly population, as it is easy to administer and can generally be completed by most older adults.

7. Nursing diagnoses

• Disturbed Thought Process.
• Chronic Confusion.
• Self-Care Deficit: Bathing/Hygiene.
• Self-Care Deficit: Dressing and Grooming.