NRSE 4560 Gerontology Student Handbook

NRSE 4560 Gerontology Student Handbook - 1 - GeroV.1 Gerontology Handbook Table of Contents Focused Exam: Pain . - 3 - Focused Exam: Mobility ................................................................................................................. - 6 - Focused Exam: Infection ............................................................................................................... - 9 - Focused Exam: Cognition ............................................................................................................ - 12 - Focused Exam: End of Life .......................................................................................................... - 15 - Self-Reflection ............................................................................................................................ - 17 - - 2 - GeroV.1 Gerontology Handbook Focused Exam: Pain This assignment provides the opportunity to conduct a focused exam on an older adult patient presenting with pain related to intense joint pain. You will assess relevant body systems to evaluate physiological symptoms. You will also interview the patient, conduct a cognitive assessment, and provide therapeutic communication. After the patient exam, you will complete an SBAR hand-off. On average, this assignment should take 90 minutes to complete. Instructions: Perform a focused examination of an older adult patient who has been experiencing intense joint pain. Gather the information needed to assess the situation and transfer care to Preceptor Diana. Plan your time: Assignment First Turn In Allow Reopening Flexible Turn In Time Estimate ~90 minutes ~110 minutes ~160 minutes Patient Examination: • Review the orders and patient data in the EHR • Interview and examine Edward Carter to gather subjective and objective patient data • Gather HPI and health history • Use the Question tab in the Communication Box to gather subjective data from Mr. Carter • Use the Education tab in the Communication Box to inform and educate Mr. Carter on relevant topics revealed in subjective data collection • Use the Empathize tab in the Communication Box to practice therapeutic communication when opportunities arise during the interview • Perform medication reconciliation to evaluate the patient’s medication regimen, polypharmacy risk, or Beers List contraindications • Interview the patient about their ability to perform activities of daily living (ADLs) • Maintain respect for the patient’s dignity while broaching sensitive subjects such as cognition and functional independence • Conduct a focused assessment of the patient's musculoskeletal system and regional systems of concern • Conduct the relevant tests to evaluate the patient’s symptoms • Analyze patient’s potential fall risk • Document the findings of the physical examination in the Objective Data Collection tab in the EHR • Document subjective data, using professional terminology, in the Nursing Admitting Note tab in the EHR Patient Hand-off: • Determine when enough information has been gathered to transfer care to Preceptor Diana • Communicate Mr. Carter’s Situation, Background, your Assessment, and your Recommendation in an SBAR hand-off to your preceptor - 3 - GeroV.1 Gerontology Handbook Tips for Success: You should prepare prior to entering Edward Carter’s room. We suggest taking out your textbook to remind yourself of what doing a Gerontology assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: Subjective Data: • Orientation • Chief Complaint • History of Present Illness • Past Medical History • Home Medications • Patient Status • Social History • Family History • Review of Systems • Functional Status & Geriatric Syndromes There are also multiple essential physical exam actions you will need to complete and record accurately in the EHR. Here are the physical exam tasks you will need to complete by using the exam menu to the right of your screen: Objective Data: • Assesses vitals • Assessed IV bag • Assessed IV pump • Inspected IV site • Inspected head and face • Inspected eyes • Inspected mouth • Inspected hips • Inspected thighs • Inspected knees • Inspected lower legs • Inspected skin • Auscultated carotids • Auscultated breath sounds • Auscultated heart sounds • Palpated PMI • Palpated knees • Palpated posterior tibial pulse • Palpated dorsalis pedis pulse • Test gait • Test fine motor skils • Test cognition • Test hip strength - 4 - GeroV.1 Gerontology Handbook • Test knee strength • Test hip range of motion • Test knee range of motion • Test skin turgor • Test capillary refill Remember when you are doing these exams that this simulation is designed to help you improve your assessment skills. Preparing ahead of time will help to set you up for success. Technical Support: Contact Shadow Health with any questions or technical issues before contacting your instructor. Support is available at - 5 - GeroV.1 Gerontology Handbook Focused Exam: Mobility This assignment provides the opportunity to conduct a focused exam on an older adult patient suffering from a recent fall and presenting or having presented with dizziness and constant leg pain. You will assess relevant body systems to evaluate physiological symptoms. You will also interview the patient, conduct a cognitive assessment, and provide therapeutic communication. After the patient exam, you will complete an SBAR hand-off. On average, this assignment should take 90 minutes to complete. Instructions: Perform a focused examination of an older adult patient who has been experiencing dizziness and severe leg pain. Gather the information needed to assess the situation and transfer care to Preceptor Diana. Plan your time: Assignment First Turn In Allow Reopening Flexible Turn In Time Estimate ~90 minutes ~110 minutes ~160 minutes Patient Examination: • Review the orders and patient data in the EHR • Interview and examine Robert Hall to gather subjective and objective patient data • Gather HPI and health history • Use the Question tab in the Communication Box to gather subjective data from Mr. Hall • Use the Educate tab in the Communication Box to inform and educate Mr. Hall on relevant topics revealed in subjective data collection • Use the Empathize tab in the Communication Box to practice therapeutic communication when opportunities arise during the interview • Perform medication reconciliation to evaluate the patient’s medication regimen, polypharmacy risk, or • Beers List contradictions • Interview the patient about their ability to perform activities of daily living (ADLs) • Maintain respect for the patient’s dignity while broaching sensitive subjects such as cognition and functional independence • Conduct a focused assessment of the patient’s musculoskeletal system and regional systems of concern • Conduct the relevant tests to evaluate the patient’s symptoms • Analyze patient’s potential fall risk • Document the findings of the physical examination in the Objective Data Collection tab in the EHR • Document subjective data, using professional terminology, in the Nursing Admitting Note tab in the EHR Patient Hand-Off: • Determine when enough information has been gathered to transfer care to Preceptor Diana • Communicate Mr. Hall’s Situation, Background, your Assessment, and your Recommendation in an SBAR hand-off to your preceptor - 6 - GeroV.1 Gerontology Handbook Tips for Success: You should prepare prior to entering Robert Hall’s room. We suggest taking out your textbook to remind yourself of what doing a Gerontology assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: Subjective Data: • Orientation • Chief Complaint • History of Present Illness • Past Medical History • Home Medications • Social History • Family History • Review of Systems • Functional Status & Geriatric Syndromes There are also multiple essential physical exam actions you will need to complete and record accurately in the EHR. Here are the physical exam tasks you will need to complete by using the exam menu to the right of your screen: Objective Data: • Assessed vitals • Assessed orthostatic blood pressure • Assessed IV bag • Assessed IV pump • Assessed site • Inspected head and face • Inspected eyes • Inspected mouth • Inspect thighs • Inspected lower legs • Inspected skin • Auscultated carotids • Auscultated breath sounds • Auscultated heart sounds • Palpated PMI • Palpated posterior tibial pulse • Palpated dorsalis pedis pulse • Palpated lower extremities • Test gait • Test fine motor skills • Test cognition • Test hip strength • Test knee strength • Test hip range of motion