NSG 4067-SU_NSG4067_WK2_P2_Ward

NSG 4067-SU_NSG4067_WK2_P2_Ward Functional assessment Assessing the Functional Elements of the Older Adult Completing a comprehensive assessment of an adult over 65 is a way for the nurse to identify any issues that need attention and help the patient have the best quality of life possible. The purpose of the screening is to provide care, preempt disease, retain good health, keep a record of health, minimize disabilities, and give a holistic approach to independent living (lecture online,wk.2). Various tools can be used to assess the patient for the functional ability during an assessment. I will use nursing tools that are applicable to the interviewed subject and analyze where potential problem areas are. After analyzing the information gathered, I will then connect the dots with formulating interventions for the problems identified. I will be discussing a 77- year-old female, AW, who lives independently at home alone. The Patient interview To ensure privacy of the person being discussed, I will refer to the interviewee as AW. AW lives alone in her single floor home close to her daughter and granddaughter. For the past seventy years she has had very few medical issues which include, arthritis, vision impairment, bursitis and plantar fasciitis (personal conversation, Appendix A) AW’s view on life is holistic and autonomous. AW has a good sense of control of her medical problems and indicates that she is “in good health”. AW agreed to a comprehensive assessment and each tool used was explained to her in detail. I believe her cognitive status was intact to understand and consent to this project. I will first discuss, as a nurse, the focus of assessment is on the day to day activities. Assessment tools1 By nursing standards, the functional assessment is completed to measure a person’s ability to perform day to day task of living and self -care (Miller, 2015, p.100). The first tool I will discuss is the Tinetti Balance tool. The use of this tool was to assess AW’s steadiness, gait, Functional assessment and her overall ability to move sit and walk. Using verbal instructions, AW was asked to perform simple task such as sitting and standing, turning around and walking steps. There were an achievable 28 points to attain and AW scored a 27 on the Tinetti (see Appendix B). With an almost perfect score, I did not feel that this was a problem area for her plan of care. The next tool described is the Katz Index of Independence in Activities of Daily Living, referred to as the Katz ADL. This tool is used to measure an elder person’s independent daily life duties. Such duties included, bathing, dressing, and toileting. The tool uses 6 activities of daily life to score the patient, and a possible total score of 6. For the Katz ADL assessment, AW scored a 6 (see Appendix C). The objective view of this tool indicates no need for interventions at this time. I would recommend that she is evaluated yearly for any decline now that a baseline has been established. The next assessment was of the home, using the Assessment of Home Safety Tool. The importance of the home assessment is to identify any fall risk factors as well as identify any environmental factors that positively or negatively affect safety, functioning, and quality of life (Miller, 2015, p.106). Having a safe home environment include proper lighting, removal of rugs and furniture, as well as efficient heating and cooling of the home. Good lighting in the home is often overlooked, but it is essential to reading, and other activities enjoyed by the older adult. Proper lighting also helps to avoid tripping over objects, and seeing a wet area that the person may slip on. The proper climate of a home is also a vital part of quality of living, making sure that the person is comfortable where they spend most of their time. I used recommendations for the home safety assessment from the text by Miller (2015) and from the Medscape website to create a tailored version for AW (see appendix D). From this assessment there were identifiable needs for intervention to make the home safer. The problems identified Functional assessment were; furniture to close to walking areas, small pets walking around the feet of AW, unsecured rugs throughout the home, and no grab bars in the bathroom area. Interventions will be discussed in another section of this essay under the section inerventions. Lastly, I assessed AW using the Barthel Index of daily function’s as an addition to the Katz ADL. When I found the Barthel Index and reviewed it, I felt that the information had already been established from the other tools used as in the Katz ADL. The main purpose for the Barthel index tool is determine the degree of independence, from any help, whether its physical or verbal to any degree. The Barthel Index is a record of what the patient does, not what they could do (). When I did the Barthel test, AW had a perfect score of 20 which correlates with her Katz score (see Appendix E). I did not recognize any issues or problem areas during this assessment of AW. The mental assessment and cognitive tools were not used on this person, because the initial interview combined with the other tools provided enough information that I did not feel she had any memory loss or dementia tendencies. This 77-year-old proved to be as independent as I am at 41 and her overall health just as good. There were some noted changes related to aging to discuss that could be potential areas of intervention. Age related changes. AW was wearing glasses and spoke of her loss of good eye sight during our time of assessments. To complete her overall functional assessment, I asked AW questions about driving at night and reading to decide if she had age related changes. I also looked at her eyes with her glasses off and noticed the yellowing of her cornea and the drooping of her top eyelid. In the text by Miller (2015, p.336) yellowing of the cornea will cause interference of light passage to the retina making glares an issue. Eyelid droop, due to loss of elasticity in the skin and the muscles around the eye, can cause problems with vision if the skin is in the line of vision. AW’s visual Functional assessment acuity is corrected by her glasses but she stated that seeing at night while driving was difficult due the glare from the lights. Age related changes to the lens, pupil, retina and retinal-neural pathways cause the older adult to have a delay in adapting to dark and light (Miller, 2015, p.337). This causes an issue for the older adult to respond as quickly when driving and meeting cars with headlights on the road. Form this assessment I identified a problem area of safety that implies a need for intervention for AW with her vision and night driving. Another age-related change to discuss is sleep. In AW’s health assessment she had complaints about trouble with sleeping patterns. Prolonged sleep latency, is the primary reason for aging adult’s loss of sleep efficiency. This is a latency is from increased time to fall asleep and increased frequency of awakenings during the night (Miller, 2015, p.512). Usually, the older adult take’s naps as way to compensate for the sleep loss. The interruption in the adult’s circadian rhythm is annoying but overall not bad for one’s health. Light sleep, known as nonREM, increases as the person ages. The non- REM phase is when hormones are released, muscles relax and restorative processes occur (Miller, 2015). This does however, cause drowsiness during the day and early rise times with late fall asleep times. AW has a need here as well for intervention to help improve her quality of life. Lastly, in considering her health issues, her focus was on arthritis pain. In her interview she stated that she did not regularly exercise but she moves around, stretches and take’s walk’s some days (see Appendix A). As cited in text by Miller (2015, p.298), adults often avoid exercise due to arthritic pain. Age related changes here are, joints become less flexible with loss of fluid to cushion them, and muscles become more lax and less tone from changes in the muscle fibers and the central nervous system (). Due to the lack of desire to exercise regularly an intervention is needed to provide her with information abou