EVANGELISTA, Gabrielle Angela B.

NCMP114 – RLE (RR31)

Assignment #1: Geriatric Assessment

1. What are the skills and techniques in communicating with an elderly?

2. How do you assess elderly adults in terms of:
a. cognitive assessment
b. functional abilities
c. physical health and psychological assessment
d. social and spiritual
3. How do you meet the safety needs of older adults?
4. Give the description, assessment, special consideration, materials needed, procedure, and rationale
when you do dialysis care.
5. Read about diabetic monitoring and put the essentials in your notebook.

Preparation:
1. Skills and techniques in communicating with an elderly:

• Use Proper Form of Address

− Establish respect right away by using formal language. Use Mr., Mrs., Ms., and so on.
Or, you might ask your patient about preferred forms of address and how she or he would
like to address you.
• Make Older Patients Comfortable
− Ask staff to make sure patients have a comfortable seat in the waiting room and help with
fill out forms if necessary. Be aware that older patients may need to be escorted to and
from exam rooms, offices, restrooms, and the waiting area. Staff should check on them
often if they have a long wait in the exam room.
• Take a Few Moments to Establish Rapport
− Introduce yourself clearly and do not speak too quickly. Show from the start that you
accept the patient and want to hear his or her concerns. If in a hospital setting, remember
to explain your role or refresh the patient’s memory of it.
• Try Not to Rush
− Older people may have trouble following rapid-fire questioning or torrents of
information. By speaking more slowly, you will give them time to process what is being
asked or said. This gives them time to take in and better understand what you are saying.
• Avoid Interrupting
− Once interrupted, a patient is less likely to reveal all of his or her concerns.
 • Use Active Listening Skills
− Face the patient, maintain eye contact, and when he or she is talking, use frequent, brief
responses, such as "okay," "I see," and "uh-huh." Active listening keeps the discussion
focused and lets patients know you understand their concerns.
• Demonstrate Empathy
− Watch for opportunities to respond to patients' emotions, using phrases such as "That
sounds difficult," or "I'm sorry you're facing this problem; I think we can work on it
together." It also has rewards in terms of patient satisfaction, understanding, and
adherence to treatment.
• Avoid Medical Jargon
− Try not to assume that patients know medical terminology or a lot about their disease.
Introduce necessary information by first asking patients what they know about their
condition and building on that. Check often to be sure that your patient understands what
you are saying. Can also ask the patient to repeat back the diagnosis or care plan in his or
her own words—this can help with recall, as well.

Reference: Tips for Improving Communication with Older Patients. (n.d.). Retrieved August 07, 2020, from
https://www.nia.nih.gov/health/tips-improving-communication-older-patients

2. How to assess elderly adults in terms of:

Cognitive Assessment Functional Abilities Physical Health and Social and Spiritual
Psychological
Assessment
— Use of Mini Mental Functional Assessment Psychological Social Assessment
State Examination — Identify older Assessment includes:
(MMSE) - to adult’s ability to — Assessment of — collecting
differentiate organic perform quality of life and information on the
from functional self-care, self- successful aging presence of a social
disorders and to maintenance, and network and on the
measure change in physical activities — Assessment of interaction between the
cognitive impairment; — Ask questions about Clinical Depression older adult and family,
measures orientation, ability and observe (Major or Minor) friends, neighbors, and
registration, attention ability through community
and calculation, short- evaluating task — Use of Geriatric
term recall, language, completion Depression Scale — Use of broad-based
and visuospatial — (GDS) – to assess social assessment that
function. symptoms of includes:
depression - asking questions
— Use of The Mini- about recent life events
Cog - another screening — Physical Physical Health - living arrangements
tool that can be Performance Measures — Based on: - everyday activities
administered in 5 - ADL and IADL - technical competence requiring help ((and
minutes or less and assessment tools such - knowledge of the who usually
requires minimal as: normal changes provides help)
training; The screening - Barthel Index - diseases associated - potential isolation
consists of a three-item - the Uniform Data with aging - adequacy
recall and a clock- System for - good of income
drawing test. This communication skills
 reliable tool can assist Medical Rehabilitation — History taking - sources of health care
nurses with early (UDSMR) Functional — Conducting of coverage
detection of cognitive Independence Measure Physical Examination
problems. (FIM) – common ADL — Review of the body Spiritual Assessment
tool system such as: — Use of the earliest
- Physical Performance - Circulatory Function guidelines for spiritual
Test (PPT) - Respiratory Function assessment developed
- Use of Canadian - Gastrointestinal by Stoll that address
Occupational Function both religiosity and
Performance Measure - Genitourinary spirituality.
(COPM) – to combine Function
elements of ADLs, - Sexual Function
IADLs, and AADLs - Neurological Function
- Musculoskeletal
Function
- Sensory Function
- Integumentary
Function
- Endocrine and
Metabolic Function
- Hematologic and
Immune Function

3. How do you meet the safety needs of older adults?

Reducing the risk for falls

• Prepare safe surroundings.

− Make sure you have adequate lighting, particularly in stairwells. Keep frequently needed
items such as the telephone, tissues, etc., on a table near your chair or bedside. Avoid
placing items on the floor, particularly near your favorite chair or bedside. Make sure
there are no throw rugs, uneven floors, electric wires, oxygen tubing, or other items that
could cause tripping. Mop up spills in the kitchen or bathroom immediately. Do not climb
on anything other than an approved step stool to reach high places.
• Allow adequate time to complete an activity or task.
− Haste increases the risk for falls or other injuries. If you feel dizzy or lightheaded, sit for
a while before standing.
• Wear proper-fitting footwear.
− Shoes with nonslip soles and low heels are recommended because high-heeled shoes
contribute to balance problems. Shoes should have closures that are easy to manipulate. If
shoes have laces, check that they do not come loose and cause tripping. Loose-fitting
slippers or shoes can drop off the foot and lead to a fall.
• Use assistive devices if needed.
− A cane or walker provides security by enlarging the base of support. These devices
should be kept close at hand to avoid leaning or reaching. The tips should have solid
rubber grips to prevent slipping and may need to be modified on icy surfaces to promote
gripping.
 • Ask for help when necessary.
− This Bible passage provides good advice: “Pride goeth before destruction, and a haughty
spirit before a fall.” Failure to seek help can lead to serious injury. Older adults should be
encouraged to recognize that good judgment is a sign of healthy aging and not a sign of
weakness
Preventing Injuries in the Home

• Ensure that all rugs are firmly fixed to the floor.

− Tack down loose edges, ensure that rubber skid-proofing is secure, and remove
decorative scatter rugs.
• Maintain electric safety.
− Check regularly to ensure that there are no broken or frayed electric cords or plugs. Any
defective electric plug or cord should be repaired by an approved repair person. Discard
all electric appliances that cannot be repaired. Install ground fault interrupt (GFI) electric
sockets near water sources to prevent accidental shocks when appliances are used.
• Decrease clutter and other hazards.
− Throw out unnecessary items such as old newspapers. Keep shoes, wastebaskets, and
electric or telephone cords out of traffic areas. Never place or store anything on stairs. Ice
should be cleared promptly from sidewalks and outside staircases. Cat litter can be used
to provide traction on icy surfaces.
• Provide adequate lighting.
− This is particularly important in stairwells. Switches should be located at both the top and
bottom of stairs. Use night-lights in the bedroom, bathroom, and hallways. The kitchen
should have adequate lighting in food preparation areas to facilitate label reading and to
reduce the risk for injury when sharp objects are used.
• Provide grip assistance wherever appropriate.
− Handrails should be installed in all stairwells to provide support for stair climbing. Grab
bars alongside the toilet and in the bathtub and shower also help provide support.
Lightweight cooking utensils with large handles and enlarged stove knobs make cooking
easier and safer for older adults.
• Place frequently used items at shoulder height or lower where they can be reached easily.
− Keeping frequently used items available decreases the need to use climbing devices. Use
only approved devices such as step stools when reaching for items that cannot be reached
easily. Ladders are not recommended for use by older adults, but if they are used, ensure
that they are fully open and locked. Excessive reaching should be avoided, and another
person should stand by to steady the ladder, reducing the risk for tipping.
• Take measures to prevent burns.
− Avoid smoking or the use of open flames whenever possible. Do not wear loose, long
sleeves when cooking on a gas stove. Check that the hot water tank setting does not
exceed 120° F. Use a mixer valve to prevent sudden bursts of hot water. Have a plan for
leaving the residence in case of fire
Thermoregulation Risks for Older Adults

• Exposure to excessively cold or hot environments

• Limited financial resources to pay for heat or clothing that is suitable for environmental
temperature
 • Neurologic, endocrine, or cardiovascular disease
• Hypometabolic or hypermetabolic disorders (diabetes, cancer, hypothyroidism, hyperthyroidism,
malnutrition, obesity)
• Infection or other febrile illness
• Dehydration or electrolyte imbalances
• Inactivity or excessive activity
• Temperature-altering medications (alcohol, antidepressants, barbiturates, reserpine,
benzodiazepines, phenothiazines, anticholinergics)
4. Description, assessment, special consideration, materials needed, procedure, and rationale when you do
dialysis care.

Description Assessment Special Materials Needed Procedure Rationale

Consideration
Dialysis Care Assessment of −Protecting the − Blood Pressure — Preparation Your weight,
— The process patients on vascular access − Carts blood pressure,
of removing hemodialysis: −Precautions −Chairs—Blood pulse and
waste products Pre-dialysis during, I.V drawing and Recliners temperature are
and excess fluid Intradialytic therapy −Diagnostic Sets checked. The
from the body. Post-dialysis −Monitoring −Dopplers skin covering
Dialysis is • Sodium symptoms of −Glucose Monitoring your access site
necessary when modeling — the point
uremia −Infusion Pumps
the kidneys are • Essential −Detecting where blood
−Instrument Stands
not able to laboratory values cardiac and leaves and then
adequately filter • Anemia − IV Poles re-enters your
respiratory − Laboratory
the blood. management complications body during
Dialysis allows • Hematocrit- − Patient Lifts & treatment — is
−Controlling Accessories
patients with based blood electrolyte levels — Starting cleansed.
kidney failure a volume − Patient Transfer
and diet
chance to live monitoring − Privacy Screens During
−Managing
productive lives. • Morbidities and −Refrigerators/Freezers hemodialysis,
discomfort and
mortalities related Scales two needles are
pain
to volume − Stools inserted into your
−Monitoring BP
retention − Tables arm through the
−Preventing
• Patient − Thermometry access site and
infections
education
−Caring for the − Waste Receptacles taped in place to
• Correct weight − Wheelchairs remain secure.
documentation catheter site Each needle is
−Administering − Syringes
pre- and post- − Tourniquet attached to a
dialysis medications flexible plastic
• Assess for −Providing tube that connects
Jugular Vein psychological to a dialyzer.
Distention support (pt and Through one
• Assess for family) tube, the dialyzer
Edema filters your blood
• Assess for Lung a few ounces at a
and Heart Sounds time, allowing
wastes and extra
fluids to pass
from your blood
 into a cleansing
fluid called
dialysate. The
filtered blood
returns to your
— Symptoms body through the
second tube.

You may
experience
nausea and
abdominal
cramps as excess
fluid is pulled
from your body
— especially if
you have
hemodialysis
only three times a
week rather than
more often. If
you're
uncomfortable
during the
procedure, ask
your care team
about minimizing
side effects by
such measures as
adjusting the
speed of your
hemodialysis,
— Monitoring your medication
or your
hemodialysis
fluids.

Because blood
pressure and
heart rate can
fluctuate as
excess fluid is
drawn from your
body, your blood
— Finishing pressure and
heart rate will be
checked several
times during each
treatment.
 When
hemodialysis is
completed, the
needles are
removed from
your access site
and a pressure
dressing is
applied to prevent
bleeding. Your
weight may be
recorded again.

Reference:
Hemodialysis. (2019, July 23). Retrieved August 08, 2020, from https://www.mayoclinic.org/tests-
procedures/hemodialysis/about/pac-20384824
Henry Schein, I. (n.d.). My Account. Retrieved August 08, 2020, from https://www.henryschein.com/us-
en/medical/products/medical-equipment/about-medical-equipment/dialysis-equipment.aspx