Walden NRNP6540 Week 1: Assessment of Older Adults
Walden NRNP6540 Week 1: Assessment of Older Adults
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CASE Study for Module 1 (6540)
History
The patient was an 85-year-old, Caucasian female admitted as a permanent resident to a long-term care facility following the death of her spouse (her primary caregiver) 35 days prior to referral to physical therapy. Her primary diagnosis on admission was Alzheimer’s disease, with a Clinical Dementia Rating (CDR) Scale score of 3, indicating severe dementia. Past medical history included: hypertension, coronary artery disease (CAD), inferior wall myocardial infarction, pernicious anemia, hyperlipidemia, reflux esophagitis, recurrent urinary tract infections, and anxiety. With a height of 63 inches, and weight of 135.2 pounds, her body mass index (BMI) was 23.9. Medications26 upon admission are listed in Table 1. Two days after the physical therapy evaluation, the patient’s primary care physician reduced her Risperdal dosage to 1 Mg bid in an attempt to reduce akathisia or restlessness which may have been causing her to experience the urgent need to move and not sit down. Walden NRNP6540 Week 1: Assessment of Older Adults
Medications Prescribed upon the Patient’s Admission to the Nursing Home
The patient was a retired beautician whose previous hobbies included knitting, gardening, and reading novels. She was a nonsmoker and rarely drank alcoholic beverages. Prior to admission, she required minimal assistance from her spouse with basic ADLs. She did not use an assistive device, but required supervision with all mobility-related activities. She had not fallen at home, prior to admission. While she was homebound in her single-family, rural home, caregivers were able to take her to medical appointments. All care was provided by her spouse without home health assistance.
She had no previous care from physical therapists.
The patient was referred to physical therapy for evaluation and intervention 35 days after admission, following 2 noninjurious falls. The first fall, unwitnessed, occurred in the living room area of the facility at 10:35 AM, 9 days prior to the physical
therapy evaluation. Urinalysis done the day after the fall ruled out a urinary tract infection (UTI) as a possible cause of the fall. The second fall, 7 days after the first, occurred in the patient’s semi-private room while she was attempting to walk around her bed at 3:10 PM. Nursing reported the patient wandered throughout the day, often to the point of exhaustion. Nursing staff verbally prompted her to sit or lie down to rest frequently during the day, as she was unable to recognize the need to do so on her own. As many as 8 times a day, facility staff observed her falling asleep while standing holding the hallway railings or leaning on furniture.
Nursing staff and primary care physician noted that the patient became agitated and anxious, and had tried to leave the facility several times to look for her husband, not remembering his death. At other times, with no signs of agitation, she willingly took part in group activities (coffee socials, musical programs, pet therapy, and visits with children’s groups) and received daily one-on-one visits from the activities director. She enjoyed weekly visits from her 3 daughters and sons-in-law and many grandchildren.
NRNP_6540 Week 1: Assessment of Older Adults
As patients age, they are more likely to develop health issues. While some of these health issues are normal changes due to aging, some of them are abnormal and require further evaluation. Consider a 92-year-old patient who has been diagnosed with several disorders, including obstructive sleep apnea, hypertension, mild chronic anemia, restless leg syndrome, and osteoporosis. Despite these disorders, he can independently perform all basic activities of daily living, walk a quarter mile without difficulty, and pass functional and cognitive assessments. However, he did report that he fell a few times and had lost his way while driving to a familiar location (Carr & Ott, 2010). As an advanced practice nurse caring for geriatric patients, you will likely encounter patients like this. While he can pass the basic assessments, the report of falls and confusion might indicate underlying issues of immobility, sensory deprivation, and/or cognitive dysfunction that require further attention. To identify these potential underlying issues and distinguish between normal and abnormal changes due to aging, healthcare providers use a variety of assessments. These assessments are a key tool in the care of geriatric patients.
This week, you examine assessment tools and evaluation plans used to assess geriatric patients presenting with potential issues of immobility, sensory deprivation, and cognitive dysfunction. Walden NRNP6540 Week 1: Assessment of Older Adults
Reference:
Carr, D. B., & Ott, B. R. (2010). The older adult driver with cognitive impairment: “It’s a very frustrating life.” Journal of the American Medical Association, 303(16), 1632–1641. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915446/
Learning Objectives
Students will:
- Analyze assessment tools used to assess older adults
- Design evaluation plans for patients with immobility, sensory deprivation, and/or cognitive dysfunction
- Identify immunization requirements related to health promotion and disease prevention for older adults
Learning Resources
Required Readings (click to expand/reduce)
Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Changes with aging. In Advanced practice nursing in the care of older adults (2nd ed., pp. 2–5). F. A. Davis.
Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Health promotion. In Advanced practice nursing in the care of older adults (2nd ed., pp. 6–18). F. A. Davis.
Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Exercise in older adults. In Advanced practice nursing in the care of older adults (2nd ed., pp. 19–24). F. A. Davis.
Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Comprehensive geriatric assessment. In Advanced practice nursing in the care of older adults (2nd ed., pp. 26–33). F. A. Davis.
Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Symptoms and syndromes. In Advanced practice nursing in the care of older adults (2nd ed., pp. 34–94). F. A. Davis.
Recommended Reading (click to expand/reduce)
Recommended Media (click to expand/reduce)
Note: View the Process of Aging video module available in this free course.
Discussion: Evaluation Plan
As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as a nurse practitioner, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of older adult patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability. For this Discussion, you will consider which assessment tools would be appropriate for a patient in a case scenario.
Photo Credit: LIGHTFIELD STUDIOS / Adobe Stock
To prepare:
- Review this week’s Learning Resources, considering how assessment tools are used to evaluate patients.
- Your Instructor will assign a case study to use for this Discussion. Review the case study and, based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
- Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments such as language, education, prosthetics, missing limbs, etc.
- Consider immunization requirements that may be needed for this patient. Walden NRNP6540 Week 1: Assessment of Older Adults
By Day 3
Post an explanation of your evaluation plan for the patient in the case study provided, and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, etc. Also explain the immunization requirements related to health promotion and disease prevention for the patient.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different days in one or more of the following ways:
- Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues’ patients.
- Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.
- Explain other health promotion considerations for patients in this population or with related issues.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link, and then select Create Thread to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Rubric Detail
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Name: NRNP_6540_Week1_Discussion_Rubric
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List View
Excellent
Point range: 90–100 Good
Point range: 80–89 Fair
Point range: 70–79 Poor
Point range: 0–69
Main Posting:
Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
40 (40%) – 44 (44%)
Thoroughly responds to the discussion question(s).
Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
No less than 75% of post has exceptional depth and breadth.
Supported by at least 3 current credible sources.
35 (35%) – 39 (39%)
Responds to most of the discussion question(s).
Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.
50% of the post has exceptional depth and breadth.
Supported by at least 3 credible references.
31 (31%) – 34 (34%)
Responds to some of the discussion question(s).
One to two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with fewer than 2 credible references.
0 (0%) – 30 (30%)
Does not respond to the discussion question(s).
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only 1 or no credible references.
Main Posting:
Writing
6 (6%) – 6 (6%)
Written clearly and concisely.
Contains no grammatical or spelling errors.
Further adheres to current APA manual writing rules and style.
5 (5%) – 5 (5%)
Written concisely.
May contain one to two grammatical or spelling errors.
Adheres to current APA manual writing rules and style.
4 (4%) – 4 (4%)
Written somewhat concisely.
May contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 3 (3%)
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Posting:
Timely and full participation
9 (9%) – 10 (10%)
Meets requirements for timely, full, and active participation.
Posts main discussion by due date.
8 (8%) – 8 (8%)
Posts main discussion by due date.
Meets requirements for full participation.
7 (7%) – 7 (7%)
Posts main discussion by due date. Walden NRNP6540 Week 1: Assessment of Older Adults
0 (0%) – 6 (6%)
Does not meet requirements for full participation.
Does not post main discussion by due date.
First Response:
Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings.
Responds to questions posed by faculty.
The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
7 (7%) – 7 (7%)
Response is on topic, may have some depth.
0 (0%) – 6 (6%)
Response may not be on topic, lacks depth.
First Response:
Writing
6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues.
Response to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in Standard, Edited English.
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues.
Response to faculty questions are mostly answered, if posed.
Provides opinions and ideas that are supported by few credible sources.
Response is written in Standard, Edited English.
4 (4%) – 4 (4%)
Response posed in the discussion may lack effective professional communication.
Response to faculty questions are somewhat answered, if posed.
Few or no credible sources are cited.
0 (0%) – 3 (3%)
Responses posted in the discussion lack effective communication.
Response to faculty questions are missing.
No credible sources are cited.
First Response:
Timely and full participation
5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation.
Posts by due date.
4 (4%) – 4 (4%)
Meets requirements for full participation.
Posts by due date.
3 (3%) – 3 (3%)
Posts by due date.
0 (0%) – 2 (2%)
Does not meet requirements for full participation.
Does not post by due date.
Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings.
Responds to questions posed by faculty.
The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
7 (7%) – 7 (7%)
Response is on topic, may have some depth.
0 (0%) – 6 (6%)
Response may not be on topic, lacks depth.
Second Response:
Writing
6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues.
Response to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in Standard, Edited English.
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues.
Response to faculty questions are mostly answered, if posed.
Provides opinions and ideas that are supported by few credible sources.
Response is written in Standard, Edited English.
4 (4%) – 4 (4%)
Response posed in the discussion may lack effective professional communication.
Response to faculty questions are somewhat answered, if posed.
Few or no credible sources are cited.
0 (0%) – 3 (3%)
Responses posted in the discussion lack effective communication.
Response to faculty questions are missing. Walden NRNP6540 Week 1: Assessment of Older Adults
No credible sources are cited.
Second Response:
Timely and full participation
5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation.
Posts by due date.
4 (4%) – 4 (4%)
Meets requirements for full participation.
Posts by due date.
3 (3%) – 3 (3%)
Posts by due date.
0 (0%) – 2 (2%)
Does not meet requirements for full participation.
Does not post by due date.
Total Points: 100
Name: NRNP_6540_Week1_Discussion_Rubric