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Running head: OLDER ADULTS HEALTH PROMOTION PROJECT 1

Older Adults Health Promotion Project

Tara Sculthorpe

Bon Secours Memorial College of Nursing

Tamera Kruikiel

Gerontological Concepts and Issues

March 21, 2018

“I pledge”
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Older Adults Health Promotion Project

I had the opportunity, on two separate occasions, to interview and assess a 71-year-old

female named Pat. These meetings took place in the woman’s home. In the first meeting, after

some catching up, we delved into the questions from the Transcultural Assessment tool. The

client was comfortable, eloquent, and open to answering each of my many questions. I gathered

from our conversation that Pat was social and active. For instance, she and her husband enjoy

frequent travel and spending quality time with their five grandchildren. Furthermore, Pat wears a

Fitbit and is diligent about tracking her activity, with a goal of reaching at least 12,000 steps per

day.

Pat is also a Type II diabetic and suffers from hypertension, which she has been dealing

with for years; however, she is well-controlled with medications, none of which are included on

the BEERS criteria list. While Pat passed each of the assessment tools with flying colors

(MMSE, GDS, Katz, ADL, SPICES), she did mention pain in her right knee which has gotten

progressively worse over the past couple of years. Particularly, she complains of joint stiffness

and pain upon standing, with some relief after a few minutes of walking. Upon discovering this

information, I utilized both the Falls Risk and Pain Assessment for Older Adults tools to assess

her further. Regarding the pain scale, Pat rated her knee pain as a 7 on a 10-point scale when

standing and first initiating movement, describing the pain as “moderate to severe”. She rated her

pain a 4 on a 10-point scale after several minutes of ambulating, and described it as “mild to

moderate” discomfort. Regarding falls, Pat displayed no risk.

According to Healthy People 2020, one of their main goals is to “improve the health,

function, and quality of life of older adults” (“Older Adults, n.d.). This includes limiting the

number of elders living with functional limitations. While Pat can get around now, without
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intervention, the condition of her knee will likely deteriorate. We discussed this, and together,

came up with a plan to get Pat back on the road to recovery.

Diagnosis & Outcomes

I formulated a nursing diagnosis for Pat which is: Pain related to orthopedic (knee) injury

as evidenced by the patient rates her pain a 7 on a 10-point scale when first standing and

initiating movement. Pat mentioned trying various interventions in the past to relieve her knee

pain such as cold compresses, as well as an over-the-counter knee brace. We discussed additional

interventions and she agreed that an appointment with an orthopedic doctor would be in her best

interest. Therefore, Pat’s short-term outcome is as follows: Patient will call and have scheduled

an appointment with her orthopedic doctor by end of day, March 5, 2018. This outcome is a

secondary prevention strategy as at the appointment, the doctor will likely screen her for

potential problems such as osteoarthritis.

Patient did express concern that having to undergo any kind of knee surgery would hinder

her ability to walk and spend time with family. I explained that the recovery period from any

surgery is temporary, and the outcome will be worth it. Also, I mentioned that even if a knee

replacement is necessary, walking frequently is often part of the recovery plan. With that said,

Pat’s long-term outcome is: Patient will express a significant decrease in pain, stating a rating of

3 or below on a 10-point scale upon standing and initiating movement by 3pm on April 1, 2018.

This is a tertiary prevention strategy as it involves working to relieve an outstanding medical

problem.

Teaching

In conversing with Pat, it’s clear she had no cognitive issues. Pat is a retired registered

nurse, having worked at both Duke and VCU, and her husband continues to own and operate a
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small business. They live in a modest home in Chesterfield, which appears clean and safe. Pat

displayed no issues regarding her hearing or vision and seemed to have much family support,

speaking with admiration about her three children, each of whom live close by. Pat was an easy

person to provide teaching to and was receptive to my suggestions.

In waiting for her appointment with the orthopedic doctor, Pat and I discussed

interventions she could utilize in the meantime. We went online and I showed her the RICE tool,

which is an easy way for her to remember potential interventions – rest, ice, compression, and

elevation (“Managing”, n.d.). She agreed to begin icing her knee each evening, as she had

“stopped doing so months ago”. As explained to the client, the cold helps to reduce pain,

inflammation, and muscle spasticity. Pat also agreed to try heat in the mornings, which may

improve blood flow to the area and reduce pain. She stated, “while I’ve tried cold compresses

before, I never thought about the benefits of applying heat. What a good idea!” Furthermore, I

encouraged Pat to continue walking as weight gain could put additional stress on the knee joint,

but with that said, listen to her body and rest as needed (Lewis, Dirksen, Heitkemper, & Bucher,

2014). Pat was open to these suggestions, and seemed appreciative of my time. She agreed to call

me after her appointment and to keep me updated on her status, at which point we would meet

again.

Results & Long-Term Goals

Pat followed up with me a couple weeks later. She was able get in rather quickly to see

the orthopedic doctor; therefore, her short-term goal of scheduling an appointment was met.

After some workup, it was determined that Pat was in fact a candidate for knee replacement

surgery as her knee joint was severely worn; however, the doctor was booked a few months out.

Pat, although a bit reluctant, scheduled her surgery for the end of May. In the meantime, the
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doctor gave her a shot of cortisone. Pat expressed that she has had a great deal of relief from the

injection, and stated that her pain is now minimal; around a 2 on a 10-point scale. Therefore, her

long-term goal has also been met. However, this relief is temporary as the effects of the cortisone

will eventually wear off. By then, Pat will have had her surgery and be on the road to recovery.

While still nervous about how this surgery will impact her lifestyle, Pat was reminded

about the benefits. Per Chandran et al. (2016), after having undergone total knee arthroscopy,

“there was a substantial relief of joint pain, increased mobility, correction of deformity and an

improvement in the quality of life of the patients” (p. 299). Therefore, in maintaining her long-

term goal, a plan has been initiated in which her family has been recruited to assist Pat

postoperatively; her husband will take her to and from her surgery, and her daughter will be

assisting with cleaning and meals as needed for a few weeks. Furthermore, I supplied Pat with an

Advice Following Knee Arthroscopy information sheet, which details a list of frequently asked

questions in addition to various postop exercises. This may prove helpful to her in addition to

any information supplied by her doctor.

Evaluation & Conclusion

As a nursing student, this project opened my eyes to worries of an elderly individual.

While my patient is relatively healthy in that her disease processes are well-controlled, as the

body ages, changes are inevitable. The elderly, just like the young, don’t want to stop what

they’re doing to deal with an injury. While my client realized she needed more invasive

interventions, she was a bit reluctant as it would temporarily affect her lifestyle. Quite frankly, I

can’t blame her. Pat was a joy to teach, and because she was so down-to-earth and receptive,

there isn’t a thing I would change regarding my teaching strategies. I’m glad that I could help Pat
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see the reality of the situation at hand, and I look forward to following up with her in May to see

how she’s doing.


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References

Advice following knee athroscopy. (2016). Retrieved April 03, 2018, from

file:///C:/Users/Tara/Desktop/Gero/Sculthorpe%20-

%20Knee%20Arthroscopy%20teaching%20tool.pdf

Chandran, R., Shetty,S., Shetty, A., Balan, B., Mathia, L. (2016). A study of functional outcome

after primary total knee arthroplasty in elderly patients. IAIM Journal, 3(7): 297-301.

Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical nursing:

assessment and management of clinical problems. St. Louis, Missouri: Elsevier Mosby.

Managing Musculoskeletal Injuries. (n.d.). Retrieved April 03, 2018, from

http://www.realfirstaid.co.uk/musculoskeletal/

Older Adults. (n.d.). Retrieved April 03, 2018, from https://www.healthypeople.gov/2020/topics-

objectives/topic/older-adults