NSG 4067 Assessing and Planning Care for an Elderly Person
NSG 4067 Assessing and Planning Care for an Elderly Person
The elderly are a group of vulnerable populations in most societies. They have complex health needs that may predispose their dependence on others. Therefore, this research paper summarizes an assessment performed on an elderly client. It explores different assessment tools’ outcomes and identifies issues, alterations, and interventions needed to promote the client’s health.
The assessment of the elderly client using the Tinetti Balance and Gait Evaluation showed that he was highly at risk of falling when undertaking his routines. The balance assessment demonstrated that the client rises from the chair using arms to help him. He also requires assistance as he attempts to rise from a chair. The client’s immediate standing balance is steady but uses a walker. He uses a walker to maintain standing balance with some evidence of staggering. He, however, works steadily with eyes closed and when turning through 360 degrees. He uses his arms to maintain a smooth motion when sitting down. The assessment of gait also revealed that the patient-initiated gait without hesitancy. His step length and height were asymmetrical. For example, the right swing foot failed to pass the left stance foot with step. The right and left step lengths were also asymmetrical. The trunk had marked sway, as evidenced by his use of a walking aid. The above balance issues were attributed to the reduced elasticity of the tendons and ligaments of the bones.
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The Katz Index of Activities of Daily Living assessment showed that the client performs all the activities of daily living independently. The client reported bathing independently and only needing help bathing the lower extremities. He also dresses independently and may need help in tying his shoes. He also reported being able to toilet, transfer himself in bed unassisted, and does not experience incontinence problems. He also feeds without any assistance. Based on the above, the client can perform all his daily living activities without any help from his family members.
The Barthel Index confirmed the client’s independence in undertaking his activities of daily living. The assessment demonstrated that the client is independent in feeding, bathing, dressing, bowels, bladder, toilet use, and transfers. He, however, uses a walking stick for mobility and assistance in climbing stairs. The client reported during the interview that he engages in regular walks to strengthen his bones and muscles. However, he was diagnosed with dementia one month ago and had to minimize walking out of their compound because of fear of getting lost. He reported that he takes a healthy, balanced diet to minimize health problems like cancer, diabetes, and fractures. He also has a diabetic foot, which is dressed weekly in a nearby public facility. The assessment showed the increased need for family involvement in the management of diabetes and promotion of his safety in familiar and unfamiliar environments to promote safety.
Home safety assessment showed the home to be moderately safe. The home had a fire extinguisher at the point of entrance with working smoke and carbon monoxide detectors at every house level. Flammable objects were distantly located from the stove area. The family reported that chimney sweeps are performed yearly. The home has an accessible phone for the emergency dial, with emergency numbers posted near the phone. The home also has a first aid kit and assistive devices for the elderly such as a walking stick. The electrical appliances are safely covered with plate covers with cords not being cracked or frayed. The floor and hallways are adequately lit, with carpeting secured and indoor stairways having side rails. The kitchen has adequate space and lighting. The parking area is safe, as evidenced by sufficient lighting and having a reasonable level.
Several issues were identified during the assessment. One of them is the inadequate support from the family members on diabetes management. The elderly client has diabetes with a diabetic wound. He visits a nearby public facility for the dressing of the wound regularly. He is also expected to monitor his blood glucose levels daily. However, the client reported that he receives minimal support from the family members in monitoring his blood glucose levels. He also attends the weekly hospital visits alone. The client also does not have a spouse to accompany him to the hospital or walk him around the community as part of his physical activity daily.
The second issue identified from the assessment is the client’s risk of injury. The client was recently diagnosed with dementia. He reported getting lost in his familiar environments. The family also reported that he often forgets their identity. The memory loss predisposes the client to risk harm due to falls and getting lost in his environment. The family should therefore ensure the prioritization of his safety needs.
The third issue identified from the assessment is the lack of awareness among the family members on diabetes and dementia. The client has diabetes and has dementia. The family members have limited knowledge on the effective management of diabetes and dementia. They also do not understand their increased predisposition to diabetes and dementia. They should therefore be educated about the risks and ways of minimizing them.
The last issue that was identified from the assessment is the need for dietary supplementation of calcium to prevent fractures in the client. The Tinetti Balance and Gait Evaluation demonstrated the client to be at a high risk of fractures. Therefore, the client and the family should be educated about the importance of increased intake of foods rich in calcium. They should also be educated on the strategies to minimize the risk of falls in the home environment.
Alterations and Interventions
Utilization of Screening Services
One of the required alterations for the client and the family is increased utilization of screening services. The client and the family should be encouraged to utilize screening services for health problems such as diabetes, hypertension, different types of cancers, and eye problems. The elderly client has diabetes. As a result, the family members should be encouraged to undergo annual diabetic screening due to their genetic predisposition. The client should also be educated on the importance of screening for prostate and colon cancer, renal and eye problems due to the increased risk of diabetic neuropathy and retinopathy. The client should also undergo regular checkups for blood pressure since he is highly predisposed to hypertension as a comorbidity of diabetes (Ishak et al., 2017). Community health nurses should also educate the community members about the importance of screening services. Health education will raise awareness among the community members, hence, increasing the uptake of screening services and early identification and management of potential cases.
Family Involvement in Client Care
The second alteration identified from the analysis is the need for family involvement in caring for the elderly client. The effective management of diabetes and dementia requires the active participation of the family members. Family members should assist the client in undertaking daily glycemic monitoring and attending the weekly dressing for the diabetic wound. Family involvement will minimize the risk of hypoglycemia, hyperglycemia, and worsening of the diabetic foot. Therefore, family members should be educated about their critical role in promoting the effective management of diabetes. The client is also at risk of injury due to dementia. The family should be involved in promoting the client’s safety. They should be educated about the importance of ensuring that the client lives in a well-lit and familiar environment. The community nurse should also link the client and his family to the available social support systems in the community for diabetes and dementia (Caner & Cilasun, 2019). Social support networks will assist the client and family learn about effective ways of coping with their health needs.
The assessment demonstrated the client is at an increased risk of falls. Falls contribute to adverse outcomes in elderly patients, such as fractures and loss of mobility. Therefore, the client and family should be educated about the importance of nutritional modification to strengthen the client’s bones. The family should be educated about the importance of increasing the intake of foods rich in calcium, such as milk. The client and the family should also be educated about the risks of high intake of diets that limit the dietary absorption of calcium. The client should also be educated on the importance of engaging in moderate physical activity to strengthen the bones and minimize calcium loss (Bischoff-Ferrari et al., 2018). The client was also educated about the signs and symptoms of bones’ low calcium levels, such as bone pain and easy fractures.
The elderly comprise the vulnerable populations in our societies. They are predisposed to health problems such as diabetes, dementia, and hypertension. The assessment of their health needs guides appropriate interventions to promote their health. Therefore, this exercise has increased my understanding of how the health needs of the elderly populations can be met.
Bischoff-Ferrari, H. A., Bhasin, S., & Manson, J. E. (2018). Preventing Fractures and Falls: A Limited Role for Calcium and Vitamin D Supplements? JAMA, 319(15), 1552–1553. https://doi.org/10.1001/jama.2018.4023
Caner, A., & Cilasun, S. M. (2019). Health Care Services and the Elderly: Utilization and Satisfaction in the Aftermath of the Turkish Health Transformation Program. Gerontology and Geriatric Medicine, 5, 2333721418822868. https://doi.org/10.1177/2333721418822868
Ishak, N. H., Mohd Yusoff, S. S., Rahman, R. A., & Kadir, A. A. (2017). Diabetes self-care and its associated factors among elderly diabetes in primary care. Journal of Taibah University Medical Sciences, 12(6), 504–511. https://doi.org/10.1016/j.jtumed.2017.03.008