NSG 4067-SU_NSG4067_W2_A2

NSG 4067-SU_NSG4067_W2_A2 ASSESSMENT & PLAN 2 Assessing and Planning Care for the Elderly Care planning is the association between service planning and comprehensive assessment of an adult over 65, which helps the nurse identify any issues that need to be addressed in an attempt to aid the patient in having the best quality of life going forward. The assessment is where the patient’s facts are gathered then analyzed and translated into areas of which need addressing. Identification of problem areas allows the nursing staff to outline the outcomes that are desired and recommend services that will enable the patient to achieve the desired outcomes. As noted in our readings the overall purpose of the screening is to” spot failing health in its preliminary stage, so that the individual can take immediate steps in damage control” (South University, 2018). This assessment should be performed to the best of the nurse’s ability, for it is one of the most important tools available to help the patient “preempt disease, minimize disability, retain independence, and keep on the track of good health” (South University, 2018). There are many tools that are available for assessing the functional ability of the patient. In this discussion applicable nursing tools will be utilized to evaluate the patient and determine potential problem areas. Once information is gathered and analyzed, formulation of possible solutions or interventions will be reviewed. The patient, or subject if you will is a 73-year-old male, JK, who lives at home alone, independently. Patients’ Background Information For the sake of privacy, the interviewee will be referred to as JK. My older adult interviewee is a 73-year-old male acquaintance who is a widower, living alone currently and independently. His wife of 40 years passed away about 5 years ago after she was involved in a tragic motor vehicle accident. JK has three children, all of whom are grown and living on their own, away from home with their families. His medical history is well documented, he reports ASSESSMENT & PLAN 3 receiving regular check-up’s through the VA clinic locally. JK admits to taking medication for the following: Hypertension, Hyperlipidemia, Benign prostatic hyperplasia, otherwise JK states he is relatively healthy. JK appears to be knowledgeable as it relates to his health, has the wherewithal to seek treatment when needed and able to make sound decisions. After detailed discussion of the plan of evaluation and each assessment tool JK then agreed to participate in the comprehensive assessment. Tools for Assessment Functional assessment is administered to measure a person’s ability to properly execute day to day task of living as well as self-care (Miller, 2015). Tinetti Balance tool is the first assessment tool utilized. It is also known as Performance Oriented mobility assessment (POMA). It provides information of maneuverability, which also indicates risk fall of the tested person. It depicts better discriminative, test-retest and predictive validity comparing fall risk with Go Test (TUG) and Timed Up. JK was given several simplistic tasks to perform such as standing, going from sitting to standing, walking up steps and then in circles. Patients who have cerebellar or proprioception problems are forced to undergo elevation. JK executed each task with ease, he has no problem with elevation, therefore the fall risk is low as suggested by the responses. JK scored a 27/28 this will not be a problem area addressed in his plan of care. The next tool utilizes was the Katz Index of Independence in Activities of Daily Living, or Katz ADL. The tool assesses the functional status to measure the ability of the client to carry out independent daily activities (Hartigan, 2007). Katz ADL uses six activities of daily living to score the patient, these duties include, bathing, toileting, and dressing self. In the assessment of the patient, it was stated that he lived alone and could perform all his daily activities independently. With a perfect score of 6/6 this is not a problem area at this time for JK, however ASSESSMENT & PLAN 4 recommendation for yearly reassessment would be beneficial now that there is documentation of JK’s baseline. The Barthel Index is a tool that also could have been utilized to assess JK’s ability to perform his ADL’s, however after conducting the Katz ADL assessment it was deemed to be redundant therefore not conducted. Barthel Index is also a tool used to measure primary disability and dependency among patients. Following the Katz ADL assessment, the evaluation of JK’s home was conducted utilizing the Assessment of Home Safety Tool. Older adults especially those who are over the age of 65 years of age are more prone to falls and with that often these falls result in injury, or worse permanent disability. The assessment of home is vital in identify issues in the home that are potential fall risk factors as well as identify any environmental factors that can positively or negatively affect patient safety, functioning, and quality of life (Miller, 2015). The key to a safe home environment is the removal of rugs, have proper lighting, and proper heating cooling device in good working order. This assessment proved there were no identifiable needs for intervention to make the home safer at this point. The home JK lives in is a new home in a gated retirement community. These homes are designed for the elderly population and safety concerns that are faced as people age are built into the design of the home and neighborhood. JK is also a “no frills” kind of guy, therefore his accommodations are very minimalistic. Age related changes During the assessment of JK it is noted that he wears glasses, when questioned about his vision JK reports in addition to poor eyesight he also has difficulty reading in low light and seeing at night. After further assessment for age-related changes it is also noted JK suffers from eyelid droop and bilateral yellowing of his corneas. The eyelid droop can interfere with vision and is due to the loss of elasticity of the surrounding skin and muscle and may fall into the line of ASSESSMENT & PLAN 5 vision if too severe. The yellowing of the cornea will cause interference of light passage to the retina making glares problematic (Miller, 2015). These common age-related issues would explain JK’s reports of decreased ability to read in dim lighting and also his difficulty seeing at night, especially while driving. Age-related changes to the eyes len, pupil, retina and retinalneural pathways often cause the elderly to have a delay in adapting from dark and light (Miller, 2015). Hence making it a safety concern for driving at night, with decrease in reaction time there is a higher risk for incident. Due to JK’s response a long with physical assessment findings it is deemed there is a potential safety risk when it relates to night time driving, therefore a need for intervention is identified. Another age-related change addressed is digestion and nutrition. There are many psychosocial factors that can influence an older person’s eating habits and appetite. Changes in the patient’s meal environment such as the loss of a companion may affect the patients eating habits as well as nutrition in a whole (Miller, 2015). As cited in text by Miller (2015, p.369), “Studies have found that loneliness, which is common in older adults who live alone, is a significant predictor of malnutrition and risk for malnutrition in older adults”. During the assessment JK mentioned he has recently noticed a loss of appetite along with discussed losing his spouse a few years ago. It is all too common that when an older adult suffers the loss of a companion, especially a life-long spouse it is difficult for them to assume the tasks traditionally performed by the spouse. In JK’s situation it is found by assessment that not only is he still grieving the loss of his loved one, this grief is also affecting the states of his nutritional wellbeing and a need for intervention is noted. Lastly, JK reports he has noticed over the last several years a change in his overall muscle strength and his body contour. Age-related changes such as decreased size and amount of muscle ASSESSMENT & PLAN 6 fibers and loss of motor neurons can greatly affect muscle function (Miller, 2015). The loss of muscle mass, strength and overall endurance is called sarcopenia (Miller, 2015). Based off of the information provided by JK related to his physical being it is noted there is a need for intervention. Issues & Interventions Below is the summary of issues identified through the interview and assessment process of JK. In addition to the issues noted listed alongside are the suggested interventions for JK to help improve his quality of life. This plan of care will utilize local community resources in an attempt to increase compliance and participation. 1. Impaired vision, difficulty with night time driving: Encourage JK to maintain proper vision health by routine vision screening, referral to specialist if deemed necessary and limit activities that require driving after dark. For the activities at night that are necessary encourage JK to carpool with the other attendees. Additionally, provide JK with schedule and route for public Linx Bus system. 2. Loneliness & Depression: JK will be provide with information on GriefShare, a support group that is based at a local church in his area. This is a program designed to help deal with the loss of a loved one. It is a series of classes that meet weekly to address all aspects of the grieving process and teach coping strategies that the patient will then utilize to combat the effects of depression and loneliness. In addition to the course work this program also acts as a support group, therefore JK will meet other locals going through the same issues. This will create a sense of belonging and initiate new friendships. 3. Improper Nutrition & Poor appetite: JK expresses that he has no desire to eat most days. Due to the passing of his spou