BACHELOR OF SCIENCE IN NURSING:

HEALTH ASSESSMENT
LABORATORY MODULE LABORATORY UNIT WEEK
3 3 13
Geriatric Adaptation

✓ Read course and laboratory unit objectives

✓ Read study guide prior to class attendance
✓ Answer and submit course unit tasks

At the end of this unit, the students are expected to:

Cognitive:

 Understand the assessment process of older clients as part of special groups

 Overcome the challenges to health assessment of the older adult
 Perform physical assessment to older clients

Affective
 Practice effective listening during class discussion
 Inquire on topics that are not completely understood
 Share opinions on the subject matter that can enhance class discussion

Psychomotor

 Follow class rules and netiquettes

  Participate during class discussion

Health Assessment in Nursing by Janet Weber and Janet Kelly 5 th edition

www.youtube.com

Assessing Older Adults

Challenges to Health Assessment of the Older Adult

Common physical findings in older adult clients have been identified throughout the discussion
of this course. It is not, however, the physiologic changes of aging alone that warrant a special
approach to assessment of the older client. Many older adults are healthy, active, and
independent despite these normal physical changes in their bodies. It is, rather, that advancing
age has a tendency to place a person at greater risk for chronic illness and disability. The term
frail elderly describes vulnerability of the old-old (80s-centenarians) to be in poorer health, to
have more chronic disabilities, and to function less independently. It is the frail elderly that are
the focus of this module.
Collecting Subjective Data:
The Nursing Health History

Adapting Interview Technique

In today’s youth oriented culture, it is not uncommon to think of physical frailty as a serious
problem. If older people experience some degree of declining health, fear of increasing
dependency may be paramount in their minds. It is essential that the nurse adapt routine
interviewing techniques to always convey that there is something positive the older
person is doing, for example, it is important to look for good nutritional habits as well as to
identify which foods are to be avoided, or to focus on everyday activities that keep an older
person ambulatory in addition to identifying risk factors for falls. The nurse needs to
acknowledge the older client’s accomplishments that have made life meaningful.

Subjective Data necessary to be collected during interview:

A. Determining Functional Status- It is an evaluation of the person’s ability to carry

out the basic self-care activities of daily living (ADLs). Such as bathing, eating,
grooming, and toileting. One commonly used tool that is thought to be the most
appropriate for assessing functional status in older clients is the Katz Activities of
Daily Living.
B. Biographical Data- Cultural norms were not always as informal as they are today.
Many older adults grew up when older people were not addressed by their names
except by those very close to them. One should always begin the interview by
addressing an older person as “Mr., Mrs., or Ms., or with appropriate title such as
Doctor, Atty, Engr, Prof. Etc. Many older people are also aware of their vulnerability
with regard to scams and fraud. Thus, they are reluctant to give out personal
information, always remember when interviewing older clients “Collect no more
information than is essential for optimal care” If the client is cognitively impaired, a
trusted caregiver may need to be involved in the history taking.
 C. Sexuality in Older Adults

Many people believe the myth that older adults do not have sex. Studies show that this is
not true. The release from fears of pregnancy, from interruptions by children in the home,
and by work-related schedules allows more relaxed opportunity for older couples to enjoy
and express their sexuality. Loss of intimacy is among the greatest losses for many older
adults. One role of the nurse may involve helping the older client to explore different
expressions of intimacy if necessary.

D. History of Present Health Concern- This questionnaire will help the nurse collect
subjective data that will answer questions regarding the patient’s: Mental Status, Fall
History, Fatigue and Dyspnea, Nutrition and Hydration, Urinary Incontinence, Bowel
Elimination, Pain Assessment.

Health Concern Questions

Mental Status Have you noticed any changes in your ability
to concentrate or think clearly enough to
keep up with your daily activities? If so, about
when did this begin? And describe what you
have noticed.

Do you believe that you have more problems

with memory than most? Do you believe that
life is empty? Have you recently had to drop
many of your activities and interests?

Are you concerned about changes in your

memory? Are you bothered by anger or
inability to control your frustrations with day
by day living?
Falls Do you ever need to grab onto something
because you feel like you’re going to stumble
or fall? Have you ever used anything to
steady yourself when you’re walking?

Have you had any recent falls? What were

you doing? Where did it occur? What other
kinds of feelings or symptoms did you have
when you fell?

Do you ever feel lightheaded or dizzy when

you get up from a chair or a bed?

Do you have any difficulty when getting up

out of bed or from sitting in a chair?

Do you have any discomfort in your legs with

activity? Can you describe your pain? How
far can you walk before the pain occurs?
Does the pain go away with rest?
Weakness: Fatigue and Dyspnea How has your energy level changed in the
last few days or weeks?

Does you ever experience shortness of

breath? If so, is it related to activity?

Do you seem to be breathing faster?

Sweating? Do you experience anorexia?

Do you have recurrent cough? Does it ever

have blood in it?

Have you experienced weight loss? Or

changes in your health along with chronic
cough?

Have you received the pneumococcal

vaccine within the past 6 years? Do you get
annual flu vaccines?
Weakness Have you experienced any changes in your
appetite in the past 6 months? If yes, when
did you first notice a decline in appetite?

Can you describe what you eat in an average

day? On a day when your appetite is less,
how would your eating habits change?

Do you limit the kind or amount of food you

eat because of problems with your teeth or
dentures

Do you feel like you are choking when you

drink water or feel like food is catching in
your throat

How much fluid do you think you drink each

day?
Urinary Incontinence Do you ever have any urine leakage or
problems controlling your urine flow?

(Male) Do you have difficulty starting a

stream of urine? Frequency? Nighttime
frequency? Dribbling? If yes. Do you ever
take any cold or sinus medications to help
you sleep?

How long has the leakage been going on?

Has it ever suddenly gotten worse?

What activities are associated with your loss

of urine control?
Bowel Elimination Do you have any problems with bowel
elimination?

Have you had a change in bowel habits

recently? Have you ever had blood in your
stools? Have you had your stools tested for
blood? What medications do you take?
 Pain Assessment COLD SPA

Character
Onset
Location
Duration
Severity
Pattern

Remember:

Common Problems in older adults warranting further investigation as identified by the acronym
“SPICES”

Skin impairment
Poor nutrition
Incontinence
Cognitive Impairment
Evidence of falls of functional decline
Sleep disturbances

For more information watch the video below:

Collecting Objective Data

There is often a fine line between deterioration of function from aging and deterioration from
disease. For this reason, it is crucial to integrate the subjective, functional and physical
assessments. The significance of a physical finding is often determined by the effect it has on
the person’s level of comfort and ability to function. A medical pathology should be suspected
whenever any physical or functional change has occurred suddenly.

Assessment Procedure:

For step by step video instructions on how to do physical assessment of older clients, please
watch the video below:

Validating and Documenting Findings

The prevalence of chronic conditions in the frail elderly redefines the meaning of normalcy.
The ability of the older adult to function in everyday activities, albeit with the environment and
pharmacologic interventions, is a more meaningful measure of normalcy than are physical
findings alone, thus the objective and subjective data must reflect a functional and physical
assessment.
1. Interview a person that you know 60 years old and above using the aforementioned
questionnaire as your guide, you can film the interview if consent from the patient was
given, if not transcribed the interview in a word document
2. Perform physical assessment to the same patient utilizing the video you have watched
as your guide. you can film the assessment if consent was provided, otherwise create a
step by step documentation of your assessment with pictures