Posted: January 5th, 2023

NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults

NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults

NRNP 6540 WEEK ONE: Week 1: Assessment of Older Adults

Student’s Name

Institution

Course Code, Course Name

Instructor’s Name

Date

Case Overview

The case involves an 81 year old, Mr. Perkin, who presented for an annual physical examination. He is progressing well and has osteoarthritis. During this visit, he requests for a flu shot. Mr. Perkin’s takes no other drugs apart from Tylenol for arthritis pain. As Mr. Perkin’s walks into the examination room, you notice that he is using a straight cane in his right hand. NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months.

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Osteoarthritis (OA) is a degenerative joint disease that often affects the knee joint and is characterized by progressive tear and wear and loss of articular cartilage. It is a common diagnosis in the elderly population and in severe cases, can result in permanent disability. The prevalence of OA is higher in males compared to females. Among people aged 70 years and older, OA has a prevalence that is as high as 40% and in those aged 60 years and older with symptomatic disease, the prevalence in males and females is 10% and 13% respectively (Chen et al., 2017). A critical evaluation of Mr. Perkins demonstrates that apart from the OA-associated pain, the disease is negatively impacting his mobility. Chen et al., (2017) demonstrates that among elderly patients diagnosed with OA, decreased mobility and pain increase the risk of falls and fall-related injuries, ability to independently perform and instrumental activities of daily living (IADLs) as well as activities of daily living (ADLs). Ultimately, patients will experience a poor quality of life (QOL) NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults.

It will be important to perform a comprehensive geriatric assessment (CGA) on Mr. Perkins as the findings can help in identifying individual healthcare needs and potential gaps in care. The nurse will use the findings of the CGA to develop a personalized plan of care for optimal and patient-centric outcomes. According to Ball et al. (2019), the CGA must include the following components; psychological, physical, socio-environmental, functional, and QoL. Considering her age and underlying diagnosis, she is at a high risk of other chronic illnesses such as cancers that can also result in pain. Therefore, while conducting a comprehensive physical examination, the nurse should evaluate whether Mr. Perkin’s pain is as a result of the OA diagnosis or other chronic underlying causes. Her comprehensive laboratory evaluation should assess for

• glycemic control,
• Urea Electrolytes  and Creatinine (UECs)
• Underlying anemia,
• Renal function  test
• Liver function test (metabolism)
• Iron, folate, and vitamin B12 deficiencies

Considering Mr. Perkin’s advanced age and comorbid OA, she is at a high risk of   sustaining a fall. Therefore, it is mandatory to conduct a fall risk assessment. One of the most currently recommended and reliable tool to conduct this assessment is the Hendrich II Fall risk Model after which, the nurse can recommended practical fall prevention measures to decrease her overall fall risk Scale (Ball et al., 2019). Besides, her current status predisposes her to a high risk of geriatric depression, which has a high morbidity and mortality.  A valid and reliable tool to evaluate for geriatric depression for Mr. Perkin is the Short Form Geriatric Depression Scale (Ball et al., 2019). His evaluation should be conducted from the comfort of her home, preferably in liaison with a home health agency. During the assessment, the nurse should evaluate the patient’s support system (family) and related dynamics.

He needs to be educated about the immunization recommendations for older adults which particularly the flu vaccine and pneumococcal vaccine (Coll et al., 2019). The care plan should prioritize adequate control of pain through dosage, drug and frequency modifications until there is adequate control. Mr. Perkin will also need the intervention of an occupational and physical therapist to regain physical and functional control NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby

Chen, D., Shen, J., Zhao, W., Wang, T., Han, L., Hamilton, J. L., & Im, H. J. (2017). Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone research, 5, 16044. https://doi.org/10.1038/boneres.2016.44

Coll, P.P., Costello, V. W., Kuchel, G. A., Bartley, J., & McElhaney, J. E. (2019). The prevention of infections in older adults: Vaccination. Journal of the American Geriatrics Society, 68(1), 207-214.

 You will choose only ONE of the case studies below to respond to: 

Please refer to your required readings and media. These are the best sources to use as APA citations and references. Yes – these are required in all of your writings! (See the note in doc sharing for more information on APA format)

Case Study 1: 

Mr. Perkins, age 81, reports for an annual physical examination. He says he is doing well. His only known problem is osteoarthritis. He also requests a flu shot. He takes no medications other than Tylenol for arthritis pain. When he walks into the exam room, you notice that he is using a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months. 

THEN: 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. 
Keep in mind that as nurse practitioners, whether you are primary care or acute care, patient and family education is always important. This includes education about medications, tests, treatment plans, immunizations, diagnosis, and health promotion.
PLEASE COVER ALL POINTS IN YOUR DISCUSSION.NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults POINTS WILL BE DEDUCTED IF ALL POINTS ARE NOT ADDRESSED!   I recommend that you write your discussion in a word document on your computer, spell and grammar check, save it, and then copy and paste into BB.   Always review the rubric in BB.

REMEMBER TO CITE AND REFERENCE IN APA 7TH EDITION WHERE NEEDED.  I also recommend that you cite your sources from the readings from your required and recommended reading lists! 

BY DAY 6: 

Respond to at least two of your colleagues on two different days in one or more of the following ways:  - put this on your calendar reminders or post on your computer as a reminder. You cannot receive a grade if you do not respond to two classmates.

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. 
There are many great geriatric assessment tools! NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults I hope you will explore and get to know many of them!   I have posted some good ones in doc sharing for you.

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). NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults

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.NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults

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.
0 (0%) - 6 (6%)
Does not meet the requirements for full participation.

Does not post NRNP 6540 WEEK ONE: Mr. Perkins, age 81 Week 1: Assessment of Older Adults main discussion by due date.