NRNP 6540 Response Post
Discussion Response To Angela's Post
Because older individuals represent a richly diverse population, the components of assessment may vary from person to person. People age at different rates and within one person organ systems age at different rates (Kennedy-Malone, Martin-Plank, & Duffy, 2019). It is important to remember that age can be just a number and not all humans will depict or have a medical profile of their age. Some individuals are healthier within little to no illnesses while others have a significant medical history and would thought to be of an higher age, which is often stereotypical. It is equally important to view every individual as their own and to evaluate, diagnose, and treat accordingly.
In this discussion I have chosen to discuss 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.
In this case study, Mr. Perkins is a fairly healthy 81 yr old male with a limited medical history. Patient only has a problem with osteo arthritis in which he takes Tylenol for his discomfort. Patient is using a cane to walk with which might be in relation to his osteoarthritis. I would continue my evaluation using the physical health assessment. I would update any new history from Mr. Perkins, asking when his right hip started hurting and if there have been any falls or trauma to the RT hip. I would follow by conducting a physical examination, checking the motor reflexes, and mobility to the RT hip and legs as well as all extremities. I would order an xray for the RT hip to insure no fracture that could be enabling that patient to walk. I would continue the assessment by asking the patient about his nutritional intake. I would then inform the patient of forms of exercise that would be good to help decrease stress and tension to the muscles around the hip joints that could be causing discomfort. Strengthening exercises build muscles around painful joints and helps to ease the stress on them (Arthritis Foundation, 2020).
Towards the end of the evaluation, I would talk to the patient regarding his flu shot and how it is necessary for him to receive one each year, ensuring patient has no allergies to eggs or latex. I would also ask if he is up to date on all of his other immunizations as they are equally important in the geriatric population, pneumonia vaccine, tetanus, Shingrix, Hep A &B, and Zoster. Altered aging‐related responses have been noted in almost all immune cells, and these changes also result in increased inflammatory markers, or “inflammaging,” in a variety of tissues in the body.2 Proper defense from infectious disease requires a highly coordinated immune response with multiple cell types from both innate and adaptive branches of the immune system working together (Coll et.al., 2019). After conversing with the patient about immunization requirements I would give him a handout that he could take home to remind him of upcoming immunizations throughout the year.
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Discussion Response Post to Jane
“Osteoarthritis is a progressive non-inflammatory degenerative disease of the diarthrodial joints, especially weight-bearing joints such as the hips and knees. It is the most common form of joint disease which causes disability that ranges from minor limitation to near immobility with varying progression rates. It is often referred to as degenerative joint disease” (Lippincott Advisor, 2020). Osteoarthritis can be extremely painful for the patient, causing loss of ability and stiffness. Due to this loss in function, it puts the patient at increase risks for falls. It can also cause a decrease in the ability to perform activities of dialing living. Falls are independently associated with functional decline and if a patient has fallen in the past there is a high risk that they will fall again, therefore assessing the gait of this patient is crucial (Rosen & Reuben,2011).
This patient needs to have his gait, balance, and risk of falls evaluated with and without his cane. Alternative ways in which to assess the stability of a patient’s gait are to assess the ability to maintain a “side-by-side, semi-tandem, and full-tandem stance for 10 seconds each, resistance to a nudge; and stability during a 360-degree turn” (Rosen & Reuben, 2011). Gait and balance disorders can also be detected by observing patients walking and performing balance maneuvers (Rosen & Reuben,2011). This can be done by visualizing the patient walking into the room, and at the same time, an evaluation of devices being used to assist with gait can be observed at this time too. Assess for quadriceps muscles by observing if the patient can get up without the use of his hands to help him rise from an armless chair, also, gait can be evaluated by how fast or how slow a patient can walk 10 feet and back, an important evaluation and precursor for falls (Rosen & Reuben,2011). This patient is using a cane to help him walk due to his right hip pain. The concern here is the wrong /incorrect use of the cane (using the cane in his right hand on his right side for his right hip ). Correct usage is to hold the cane on his good side, thus in his left hand, on his left side for his right hip pain (Larson,2018).
The patient is also coming in for an annual physical and flu shot. This patient should be thoroughly examined and focus on gait and balance should be paid attention to which can be done in the exam room. This patient needs education on how to correctly use assistive devices such as his cane, along with an orthopedic evaluation due to his worsening symptoms within the past 6month. Also, evaluate his medication regime and make adjustments as needed such as recommending a stronger pain medication added to his regimen. Order for an x-ray of his hip, a radionuclide bone scan to rule out inflammatory arthritis, magnetic resonance imaging to show the affected joint, adjacent bones, and disease progression, and routine last but not least blood work (Lippincott Advisor, 2020).
It may also be necessary to involve both physical therapy as well as occupational therapy for exercises to target the area of concern, which in this case would be his hip. Another goal of therapy is to improve range of motion, and relieve these symptoms and improve quality of life while minimizing medication-related adverse events. When assessing the elderly, traditional medical assessment alone is often not enough due to the thought that with aging comes a decrease in function as well as falling (Rosen & Reuben, 2011). Other problem areas that would be of concern are any sensory deficits, such as hearing or seeing because these too can have an impact on fall risk. The 77-year old patient is at risk for falls due to his increased pain as well as his use of a walking assistive device.
