Running head: Senior Health Promotion 1

Senior Health Promotion Project

Chelsea Acree

Professor Tamera Krukiel, RN, MSN, ANP-BC, PMHNP-BC

Bon Secours Memorial College of Nursing

NUR 4113  Gerontological Concepts and Issues

November 4, 2017

“I have neither given nor received aid, other than acknowledged, on this assignment or test, nor
have I seen anyone else do so.” Chelsea Acree
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Senior Health Promotion Project

The client assessed for the health promotion project is an 81-year-old, Caucasian female

that requires assistance with activities of daily living and meal preparation, and utilizes a

wheelchair for mobility. Completion of the SPICES assessment tool revealed issues with

incontinence, confusion and feeding, necessitating further investigation in identified areas. The

client achieved a score of one on the mini-cog assessment, supporting her current medical

diagnosis of dementia. The client scored one point on the KATz ADL assessment, indicating

dependence for assistance. The findings from the Geriatric Depression Scale assessment were

suggestive of depression as the client received a score of six. Additionally, the Urinary

Incontinence Assessment in Older Adults: Part II- Established Urinary Incontinence was selected

for this client due to findings of the SPICES tool. Completion of the Urinary Incontinence

Assessment in Older Adults revealed that the client’s experience of incontinence impacts social

aspects of life and emotional health.

The nursing diagnosis of highest priority identified for this client is risk of aspiration

related to impaired swallowing and advanced age. I found this nursing diagnosis to be

appropriate for the client as they often experience episodes of coughing after swallowing liquids

of low viscosity. The client reports that she “gets choked easily.” The selected short-term

outcome states that the “Patient will maintain a patent airway as evidenced by normal breath

sounds, absence of coughing, no shortness of breath and no aspiration by 1400 on Oct. 21”

(Gulanick & Myers, 2014). Achievement of the short-term goal was based on physical

assessment findings, which included respiratory rate within normal parameters, unlabored

breathing, absence of adventitious lung sounds upon auscultation, skin color consistent with race,

and no coughing or signs of aspiration. The short-term goal was achieved within the established
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time frame. The long-term goal entailed that the “Patient is free of signs of aspiration and the risk

of aspiration is decreased by 1400 on Nov. 4 as evidenced by normal respiratory status, absence

of cyanosis, adventitious lung sounds and fever, and active participation in implementing the

treatment plan to optimize safe nutritional intake” (Gulanick & Myers, 2014). In order to reduce

the risk and occurrence of aspiration, I developed a treatment plan optimizing safe nutritional

intake and provided education to the client and her caregiver. The teaching plan is applicable to

Healthy People 2020’s goal of increasing the proportion of older adults who are up to date on

preventive measures. Completion of the Survey of Preferred Learning Methods tool provided

guidance regarding how to best present new information to the client. Findings indicate that the

client prefers auditory learning and repetition.

The client’s current medical history of dementia impairs her ability to retain new

information; therefore, I incorporated a visual reminder to reduce the risk for aspiration by

placing a “Safe Swallowing” checklist on the client’s kitchen table where she regularly eats

meals. Education regarding identification of aspiration and methods to reduce the risk was

provided to the client on multiple accounts; however, possessing knowledge of the client’s

barriers to retaining new information, I focused the teaching toward the client’s caregiver. I

provided teaching regarding identification of aspiration, such as the abrupt onset of respiratory

symptoms (i.e., coughing, cyanosis, etc.) associated with nutritional intake and changes in voice

(i.e., hoarseness, gurgling after swallowing). I emphasized that small volume aspirations may not

produce overt symptoms, and often are undetected until the condition progresses to pneumonia;

therefore, it is important to periodically check temperature. I informed the caregiver that older

adults may have a lower body temperature in comparison to younger individuals, and highlighted

the significance of reporting changes in body temperature to the client’s primary care provider. I
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recommended that the client receive supervision during nutritional intake to ensure upright

positioning in a chair during nutritional intake and for at least 30 to 45 minutes afterwards,

absence of drowsiness during oral intake, food is divided into bite-size pieces, avoidance of

difficult-to-swallow foods (i.e., peanut butter, popcorn, celery, etc.), chin-tuck maneuver,

alternation of solid and liquid boluses and refrainment from reloading a spoon or fork until there

is confidence that a successful swallow has been completed (Metheny, 2012). To reinforce the

information presented, I provided printed education in layman’s terms for the client and

caregiver to refer to. Provision of printed resources were appropriate as the client and caregiver

do not experience visual impairment and are capable of reading. During subsequent visits, I

inquired about methods to prevent the occurrence of aspiration. The client acknowledged that she

is as risk for aspiration by stating “I know I have to be careful not to get choked;” however, she

is not able to recite each discussed method for preventing aspiration. The caregiver adequately

recalled signs and symptoms of aspiration, as well as preventive measures. The nursing

outcomes met categorical classification of primary prevention as they sought to reduce causative

risk factors for aspiration.

Completion of this project further reinforced the importance of tailoring the delivery of

education to meet client needs based on thorough assessment. Fulfilling the role as a client

educator triggered feelings of accountability. I felt that the client and caregiver sought answers to

an issue that I identified during the assessment. I served as a translator, converting medical

jargon into layman’s terms that are understandable by the client and caregiver. Additionally, the

client’s barriers to learning new information were taken into account when developing a teaching

plan. To promote maintenance of the established long-term outcomes, I provided a “Safe

Swallowing” checklist to be kept at the client’s kitchen table where she regularly eats meals and
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educated the client’s caregiver regarding identification and prevention of aspiration. Revision of

the teaching plan would incorporate additional visits to reinforce information and monitor

achievement of the long-term goal.

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References

American Association of Critical Care Nurses. (2016). AACN practice alerts: Prevention

of aspiration. Critical Care Nurse, 36(1). doi: 10.4037/ccn2016831

Cichero, J. (2013). Thickening agents used for dysphagia management: effect on bioavailability

of water, medication and feelings of satiety. Nutrition Journal, 12(54). doi:10.1186/1475-

2891-12-54

Gulanick, M., & Myers, J. (2014). Nursing Care Plans: Diagnoses, Interventions, and

Outcomes(8th ed.). Philadelphia, PA: Elsevier.

Metheny, N. A. Preventing Aspiration in Older Adults with Dysphagia. Retrieved from

https://consultgeri.org/try-this/general-assessment/issue-20

Safe Swallowing Tips. Retrieved from

https://healthonline.washington.edu/document/health_online/pdf/Safe_Swallowing_Tips_

11_11.pdf

Sayadi, R., & Herskowitz, J. Swallow Safely. Retrieved from

https://www.brainline.org/article/swallow-safely
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