Question

1--Discuss mental health in the patient in the hospital setting.

2--Discuss functional abilities in the geriatric patient. Give specific example in your text.

3--Discuss Assessment in the geriatric patient in the hospital. Fucus on 3 areas only.

Answer 1

1. All the client experience some sort of fear while being admitted to the hospital. Anxiety, fear, threats to their body image, fear about financial burden and to the strange environment of hospital. Stress can aggravate the already worsened health status.

Female client worried about their children, disruption of family routine and also in their marital relationship.

Males may worried about the treatment, financial burden, discomfort due to health condition.

Children develop feeling of mistrust, fear of pain and strange environment.

Elderly client may feel irritable, anger due to the strange environment. May found to become suspicious about everything regarding their care and treatment. They may think and feel that they are not being given right treatment and proper medicine. They may develop a complaining nature for no reason, they found complain about everything their food, the beds on which they rest, carelessness of the serving nurses.

Nurses response would be the nurse should be friendly and unhurried to the client. Make the patient feel ease and to develop a trust worthy relationship. The patient should be received like a guest. Thus much of the client fear can be alleviated by skilled admission. Confidence and competence from nurse have a positive influence on the patient.

2. Functional ability refers to a person able to perform task require for living. Two division of functional ability noted they are: Activity of daily living and instrumental activities of daily living.

Activity of daily living are self care that person perform daily, such as eating, dressing, bathing, transferring between bed and chair and using toilets.

Instrumental activities of daily living are activity needed to live independently doing housework, preparing meals, taking medicine, managing finance.

3. Geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate older person functional ability, physical health, cognition, mental health and socioenvironmental circumstances.

• Physical health evaluated include nutrition, vision, hearing, fecal and urinary continuance, balance.

- Nutrition assessment is important because inadequate micronutrients intake is common in older person. Older person predispose to vitamin and mineral deficiency. Vitamin A,C,D,B12, calcium,zinc,iron are often deficient in older population.

Components of geriatric nutritional assessment are : Nutritional history performed with a nutritional health. Record patient food intake 24 hours recall. Physical examination particularly associated with inadequate nutrition or overconsumption.

- vision : Most common cause of vision impairment in older person include presbyopia, glaucoma, diabetic retinopathy, cataract, age related macular degeneration. Examination by use of Snellen chart to screen visual acuity. If older person has diabetes for at least five years have assessment by opthalmologist.

- Hearing : Presbycusis hearing impairment occur in oldage. Audioscope Examination, otoscopic examination, whispered voice test recommended.

• Cognitive and mental health : The increased dependency that older person may experience can leads to hopelessness, helplessness, lowered sense of self control, and decreased self esteem, self worth these changes can interfere with daily functioning and leads to depression. Depression geriatric scale and Hamilton depression scale used as screening tool. Dementia is a syndrome were deterioration of memory, thinking, behavior and ability to perform everyday activities. Several screening test available to assess cognitive dysfunction, mini cognitive instrument.
• Socioenvironmental circumstances: Determining the most suitable living arrangements for older patient is a important function in geriatric assessment. Private home in community, assisted living residence, skilled nursing facilities ( rehabilitation hospital, nursing homes ). Factors affecting the patient socioenvironmental circumstances include their social interaction network, available support resources, special needs, environmental safety.