ch 7 - health assessment Flashcards
special considerations for older adult assessment (6)
- listen patiently
- allow for pauses
- ask questions that are not often asked
- observe for minute details
- utilize all resources available
- recognize normal v abnormal aging changes
what is included in a health history (6)
- demographic info
- past medical history
- current meds and supplements
- social history
- functional history
- review of systems
factors that may affect the collection of info for health history for older adult (6)
- visual/auditory acuity
- manual dexterity
- language and health fluency
- adequacy of translation of materials
- availability of trained interpreter
- cognitive ability and reading level
what systems are included in review of systems before physical exam (11)
- constitutional
- senses
- respiratory
- cardiac
- vascular
- urinary
- sexual
- musculoskeletal
- neurological
- GI
- integumentary
special considerations when assessing older adult: height and weight (2)
monitor for changes in weight:
- weight gain (especially if pt has HF)
- weight loss (malnutrition, dentures, dementia)
special considerations when assessing older adult: temperature
-even low grade temp can indicate serious illness
special considerations when assessing older adult: blood pressure
-take postural bp (look for HTN and orthostatic hypoTN)
special considerations when assessing older adult: skin
-check for skin cancer
special considerations when assessing older adult: ears (2)
- increased hair can make visualization of ear canal/tympanic membrane difficult
- may not be able to straighten out ear canal entirely
special considerations when assessing older adult: hearing (3)
- cerumen impaction is common. remove before assessing hearing and tympanic membrane
- presbycusis is common
- evaluate hearing function
special considerations when assessing older adult: eyes (2)
- small pupils common
- gray ring around iris is normal
special considerations when assessing older adult: vision (3)
- test visual acuity
- need for more light to read is common
- decreased color discrimination
special considerations when assessing older adult: mouth (3)
- excessive dryness common
- periodontal disease common
- decreased taste and thirst
special considerations when assessing older adult: neck
-carotid arteries may appear enlarged but just because of loss of subq fat
special considerations when assessing older adult: chest/pulmonary (2)
- kyphosis/barrel chest can alter location of lobes
- higher risk aspiration pneumonia
special considerations when assessing older adult: heart (2)
- listen for murmurs and extra heart sounds (S4 can be common)
- observe for edema (especially lower legs)
special considerations when assessing older adult: extremities (2)
- edema is common
- DP and PT pulses may be hard to palpate
special considerations when assessing older adult: abdomen/GI (2)
- auscultation of bowel sounds may be difficult because of increased fat
- hemorrhoids are common
special considerations when assessing older adult: musculoskeletal (3)
- ROM (for osteoarthritis)
- observe gait
- observe for heberdens nodules
special considerations when assessing older adult: neurological (3)
- diminished/absent achilles reflex is common
- slowed reflexes are normal
- slight memory loss common
special considerations when assessing older adult: GI (4)
FEMALE: -decreased size sexual organs -sparse hair MALE: -decreased size sexual organs -thin and graying hair
what are common areas of concern in older adults (geriatric syndromes) (6)
- falls and gait abnormalities
- frailty
- delirium
- urinary incontinence
- sleep disorders
- pressure ulcers
Evaluation of person’s ability to carry out basic tasks
for self-care and tasks needed to support
independent living
functional assessment
Assesses the patient’s ability to think, process,
remember
cognitive assessment
common mental illness for older adult with chronic illness and/or living in long term care
depression
complications of untreated depression in older adults (4)
- increased functional impairment
- prolonged hospitalizations/nursing home stays
- lowered quality of life
- increased morbidity and mortality
2 assessment tools for older adults
- FANCAPES
- SPICES
what is FANCAPES
F: fluids A: aeration N: nutriton C: communication A: activity P: pain E: elimination S: social skills
what is SPICES
S: sleep disorders P: problems eating I: incontinence C: confusion E: evidence of falls S: skin breakdown
3 tools for assessment of ADLs
- katz index
- barthel index
- lawton IADL scale
6 normal ADLs to ask about
- bathing
- dressing
- toileting
- trasferring
- continence
- feeding/eating
instrumental activities of daily living to ask about (8)
- ability to use telephone
- abilities related to travel
- shopping
- self med admin
- food prep
- handling finances
- housekeeping
- laundry
what is FAST and how many stages are there
functional assessment staging tool
7 stages
7 stages in FAST
- normal adult (no noticeable decline)
- normal older adult (personal awareness of some functional decline)
- early alzheimers (noticeable deficits in demanding job situations)
- mild alzheimers (requires assistance in complicated tasks)
- moderate alzheimers (requires assistance in choosing proper attire)
- moderately severe alzheimers (requires assistance to dress, bathe, and toilet, incontinent)
- severe alzheimers (very impaired speech ability, progressive loss of abilities to walk, sit up, smile, and hol head up)
tools for cognitive assessment (4)
- mini mental status exam (MMSE)
- clock drawing test
- mini cog
- MoCA
A screening tool to identify impairment and
monitor a wide range of cognitive skills
mini mental status exam (MMSE)
what does the MMSE evaluate (6)
- orientation
- short term memory
- attention
- calculation ability
- language
- construction
2 tools for screening depression
- geriatric depression scale
- cornell scale for depression w/ dementia
2 comprehensive geriatric assessment tools
- OARS: multidimensional functional assessment questionnaire
- resident assessment instrument
what factors are considered in measurement of quality of care in SNF for short term pts (5)
- self report severe pain
- pressure ulcers: new/worsened
- assessed for/given seasonal flu vaccine
- assessed for/given pneumococcal vaccine
- newly received antipsychotic med
what factors are considered in measurement of quality of care in SNF for long term pts (9)
- one or more falls w/ major injury
- developed UTI
- developed incontinence
- foley catheter
- physical restraints
- increased need for assistance with ADLs
- excessive weight loss
- showed depressive symptoms
- received antipsychotic med
what is SNF
skilled nursing facility
utilized in SNFs to develop a plan of care for the
residents and identify factors that might lead to hospitalization
OASIS C1
what is included in OASIS C1 (9)
- h/o falls
- unintentional weight loss 10+ lbs in past year
- 2+ hospitalizations in past 6 months
- 2+ ER visits in past 6 months
- decline in mental, emotional, or behavioral status in past 3 months
- h/o difficulty complying with medical instruction in past 3 months
- currently taking 5+ meds
- currently reports exhaustion
- other
what assessment tool is helpful in identifying when a person first needs help and can help measure improvement/decline especially after stroke (often used in rehab facilities)
barthel index
activities considered necessary for independent living in many cultures
instrumental activities of daily living (IADLs)
what does the clock drawing test test for
constructional apraxia (early indicator of dementia)
what does the OARS multidimensional functional assessment questionnaire assess (5)
- social resources
- economic resources
- mental health
- physical health
- ADLs and IADLs
who is required to use the resident assessment instrument tool
SNFs that receive medicaid/medicare
when would RAI be used? OASIS C1?
RAI: skilled nursing facilities
OASIS C1: home care settings
what factors can complicate the assessment of an older adult (7)
- difficulty differentiating (ab)normalities
- coexistence of multiple diseases
- underreporting of S+S
- extensive amount of history
- atypical/nonspecific presentation of illness
- increase in iatrogenic illness
- sensory impairments
Assesses the basic Activities of Daily Living are those tasks needed for self-care and include eating, toileting, ambulation, bathing, dressing, and grooming
katz index
assessment tool: Used in rehabilitation settings and measures the amount of physical assistance needed when a person can no longer carry out ADLs independently.
barthel index
Assesses ability to do tasks needed for independent living and include cooking, cleaning, doing laundry, using the telephone and accessing means of transportation, taking medicines, yard work, shopping, and money management.
lawton IADLs
Useful for screening and monitoring cognitive function. It tests orientation, short term memory and attention, calculation ability, language, and construction (executive function).
mini MSE
Useful in screening depression in older adults because it deemphasizes physical complaints, libido, and appetite.
geriatric depression scale
Assesses ADLs, IADLs, memory, recalling events, and finding one’s way outdoors.
blessed dementia scale
Assesses short-term memory and executive function by using the three item-item recall of the MMSE combined with the Clock Drawing Test.
mini cog
