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Advanced Pathophysiology: Geriatric Patient Essay

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Updated: Mar 20th, 2022

Geriatric patients experience multisystem failure, largely as a result of body fragility and susceptibility to numerous illnesses. When Elli Baker, who is aged 73-years, was transferred to the Emergency Room(ER), the nurse noted a few details before she became unresponsive. Therefore, for the nurse to carry out an assessment of Elli’s homeostasis, oxygenation and level of pain, specific medical and clinical procedures need to be followed. The patient’s assumptions about her body functional and biological status need to be made and for the actual revelation of the patient’s nature of the problem, direct assessment is required.

The assessment process will start with the utilization of the ECOG performance status (PS) scale or popularly known as the Karnofsky scale, which will enable the nurse to assess the patient’s level and capability to withstand therapy (Browner, n.d). Thereafter, the nurse together with other Geriatricians will need to utilize a combination of performance scales and a global direct assessment, one of which is the Comprehensive Geriatric Assessment-CGA (Browner, n.d).

While carrying out this direct assessment, it is always medically recommended to adhere to the eight domains of direct assessment, which include “function, comorbidities, cognition, emotion, geriatric syndrome, nutrition, pharmacy, and socioeconomic status” (Browner, n.d, p.1). Carrying out the direct assessment specified tools such as “Charison Comorbidity Index, Cumulative Illness Rating Scale-Geriatrics (CIRS-G), Geriatric Depression Scale (GDS) and Folstein Mini-Mental Status are used” (Browner, n.d, p.1). Other tools will include FACES rating scale which utilizes facial expressions to rate the patient’s level of pain and SLUMS scales for geriatric syndromes.

Physical assessment for the patient should involve a review of all systems, vital signs, examination of the eyes, skin, lungs, cardiovascular system, head and neck, musculoskeletal system, abdomen and neurologic system (Hutchinson and Sleeper, 2010). In addition, typical vital signs to assess include blood pressure, pulse, temperature, respiratory rate, and pain where the practitioner should evaluate the patient to locate the type of pain the patient is experiencing.

About blood pressure, the practitioner needs to select the correct size cuff, for instance, one which is small, regular or large and it is advisable to inflate the cuff to approximately 200 mmHg or higher than this before deflating the cuff (Hutchinson and Sleeper, 2010). Further, a full medication assessment of the patient is essential. This can be done through assessment of the patient’s current use of prescription drugs and over-the-counter vitamins, supplements, and herbal medications coupled with the patient’s pharmacy contact information (Hutchinson and Sleeper, 2010).

Numerous technological tools exist that are utilized in treating geriatric patients. For instance, about Elli Baker, to determine her basic activity of daily living (ADL), two popular instruments are used; the Barthel ADL and Katz index of ADL (Luk, Or and Woo, 2000). In addition, to determine her instrumental ADL (IADL), the Lawton IADL scales will be used. With regard to her cognitive function an instrument known as Abbreviated Mental Test (AMT) and the Folstein Mini-Mental State Examination (MMSE) will be used (Luk, Or and Woo, 2000).

To assess her depression level, popular tools such as; Yesavage Geriatric Depression Scale, the Hamilton Rating Scale for Depression, Selfcare (D), and the Zung Self-rating Depression Scale will be used (Luk, Or and Woo, 2000). To assess her gait and balance, two important tools will be utilized; the Berg balance scales (BBS) and the Timed Up and Go Test-TUG (Hutchinson and Sleeper, 2010). Utilization of these tools has been preferred due to their ability to effectively measure the severity of the disease in a geriatric patient while at the same time, detect changes. As a result, a comprehensive assessment of the patient becomes possible, which in turn enables the medical practitioners to administer appropriate medication and treatment to the patient.

About data collection and how it was prioritized in the case of Elli Baker, first data collection processes involved the collection of data concerning the patient’s past medical history, family history, nutritional history, social history and miscellaneous history. The data collected in this case was important in that, it formed the basis upon which clinical pathways and treatment for the patient could take place.

Developing a clinical pathway for the patient was found to be important in that, the patient’s medical problems were quickly identified, and implementation of the clinical pathway led to minimal level of care for the geriatric patient. Furthermore, clinical pathway guidelines provided many opportunities to device individualized care systems for the patient, which in essence, are unique and meet the expectations and needs of the patient.

Assessing pain for a geriatric patient who is alert may proceed as follows: first, start by asking the patient key questions and noting his or her response to the pain, for example, ask him or her to describe the duration, severity and source of his or her pain. At the same time, it is important to look for physiologic or behavioral clues manifested by the patient as a result of pain’s severity (Williams and Wilkins, 2003). In addition, it is always recommended to tailor the questions to the patient’s cognitive level and allow sufficient time for the older patient to respond. Further, advice given is that, it is always important to consider the patient descriptions and the practitioner’s own observation of the patient’s physical and behavioral responses in order to properly assess pain (Williams and Wilkins, 2003).

Suggested questions to ask an alert geriatric patient in pain include: “where is the pain located, how long does it last, how often does it occur, what does the pain feel like, what relieves the pain or makes it worse, how do you usually get relief from it?” (Williams and Wilkins, 2003, p.435). Furthermore, the practitioner should ask the patient to rank his or her pain on a scale of zero to10 where zero indicates lack of pain while 10 indicates the worst pain level (Williams and Wilkins, 2003).

For a patient who is not alert, pain assessment may include does the patient needs aggressive airway management or pharmacologic intervention; how is the patient breathing, is it labored, shallow, fast, or effective; how are the patient’s oxygen saturation and bedside glucose? In addition, what are his or her heart rate/rhythm and pulse ox; does the patient manifest chest pains, headache, difficulty breathing, speaking or even concentrating; does the patient manifest insomnia, restlessness, nausea or vomiting? (Keim, 2004).

Management of pain among geriatric patients is always a failure due to a lack of proper assessment of pain and sometimes underreporting by the affected patients. To manage pain in the above patient, the concerned practitioner must provide required and adequate analgesia to the patient by understanding various types of pain, both nociceptive and neuropathic; and subsequently utilizing nonopioid, opioid and adjuvant medication (Cavalieri, 2007).

For pain management to be successful for the geriatric patient, the practitioner is required to know the patient’s habits, baseline cognition, baseline organ function, cardiovascular function, and social stresses. Further, effective communication is necessary to achieve pain management goals. Overall, successful pain, management for geriatric patients constitutes effective and appropriate pain assessment where the patient should be part of the pain management plan. Moreover, when the pain assessment goals can be fulfilled with fewer indications of failures, then the pain management plan is said to be successful.

The overall lesson I have learned concerning the assessment of the geriatric patients is that the assessment should involve medical, family, social, sexual, nutritional and miscellaneous history where also the assessment process involves assessment of: cardiovascular system, respiratory system, musculoskeletal system, neurological system, gastrointestinal system, renal system, and integumentary system (Hutchinson and Sleeper, 2010). For effective care of geriatric patients, a collaborative team of health care providers is needed. The team generally involves a physician, NP, PA, social worker, psychologist, and other numerous therapy specialists.

References

Browner, I. (N.d). Applications in Geriatric Oncology. Geriatric Education Center Consortium, John Hopkins Medicine. Web.

Cavalieri, T. A. (2007). Managing Pain in Geriatric Patients. Journal of American Osteopathic Association, Vol. 107, No. 4, pp.10-16. Web.

Hutchinson, L. C. and Sleeper, R. B. (2010). Fundamentals of Geriatric Pharmacotherapy: An Evidence-Based Approach. MD: ASHP. Web.

Keim, S. M. (2004). Emergency Medicine on Call. NY: McGraw-Hill Professional. Web.

Luk, J., Or, K. and Woo, J. (2000). Using the Comprehensive Geriatric Assessment technique to assess elderly patients. Medical and Geriatrics Unit, Shatin Hospital, Hong Kong. Web.

Williams, L. and Wilkins. L. (2003). Handbook of geriatric nursing care. PA: Lippincott Williams & Wilkins. Web.

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