TAGUM DOCTORS COLLEGE, INC.

Mahogany St., RabeSubd., Tagum City

E-Mail: tdci_007@yahoo.com
Website: TagumDocollege.com

NURSING DEPARTMENT

A. Name: Mrs. D Sex:Female

Age: 68 years old Race/Ethnicity:Filipno

Date of admission/or first contact:10/4/2021 Referral source:

Previous occupation or present employer:

GERIATRIC ASSESSMENT TOOL

BODY PARTS NORMAL ACTUAL FINDINGS INTERPRETATION

FINDINGS

INTEGUMENTARY

SKIN Texture and turgor caused by multiple

changes. Loss of Silvery scales medications.
stretch and resilience. (psoriasis) noted on
tend to be dry. elbows and lower legs.

FINGERNAILS AND n/a

TOENAILS

HEAD AND NECK

Normal
head is head is
normocephalic normocephalic
Nose and

Sinuses

Nose n/a

Sinuses n/a

Mouth Pharynx and

Mouth Pharynx and

Eyes and Ears

Eyes

Ears
Tympanic membranes Tympanic membranes
are pearly grey are pearly grey normal

Cardiopulmonary
 Heart and Vascular regular heart rate regular heart rate normal

Thorax and Lungs N/A

Gastrointestinal

Abdomen normal
abdomen is soft, abdomen is soft,
nontender, and nontender, and
without suprapubic without suprapubic
tenderness tenderness
Nutritional and n/a

Metabolic Pattern

Genitourinary

Genitourinary and n/a

Gynecologic

Breast n/a

Musculoskeletal Left head femur

fracture
Neurologic

Mental and patient is able to early stage Alzheimer’s

respond to stimuli at she is awake, alert, disease
Emotional Status
the same lower level of and oriented to person
strength but not to place or
time

Cranial Nerve n/a

Function

Sensory Function n/a

Motor Function n/a

B.  SOCIOCULTURAL ASSESSMENT

Name: Mrs. D Sex: Female

Age: 68 year old Race/Ethnicity: Filipino

Date of admission/or first contact:10/4/2021 Referral source:

Previous occupation or present employer:

I. Identifying data

n/a

II. Environment

n/a
III: Socioeconomic Level and Life-Style

Mrs. D attends a social adult day care program 3 days a week and is able to prepare light cold
meals, such as cereal for breakfast or yogurt for a snack
IV: FAMILY PATTERNS

Mrs. D, a widow and only child, lives in a “mother-daughter” home in a first-floor, 1-bedroom
apartment. She is financially “well-off”. Her daughter, her only child, lives in the second floor, 3-
bedroom apartment with her husband and 3 children all under the age of 12.

V.Family Functions and Interactions:

“mother-daughter” relationship

VI: RELIGIOUS PRACTICES

n/a

VII: MEMBERSHIPS

n/a

VIII : PERSONAL VALUES  (consider expressed ideal vs. real)

n/a

a. What are your ideas about the following:

Man and the environment relationship?

Privacy vs. group interaction (being with others)?

Possessions (personal vs. shared)?

b.  Time orientation:

Do you like to have things done promptly?

Do you rely on past experiences primarily?

Do you like to plan ahead into the future?

How do you feel if you know that you or someone else is going to be late to an event?

 c. Work or Activity – Leisure Orientation:

How much time do you spend in work tasks daily?

Do you prefer to be busy?  Sitting and thinking; Reading or relaxing?

What do you do to relax?

How much time do you spend in leisure daily?

 d. Attitude toward change:

e. Education:

f. Health-Illness Value or Definitions:

Activities of Daily Living Survey

Independent Needs assistance,describe type of assistance needed Dependent

Bathing (yes) Any Comment (yes)

Dressing (yes) Any Comments (yes)

Toileting * (yes) Any Comments (yes)

Feeding (yes) Any Comments (yes)

Transferring (yes) Any Comments (yes)

Ambulating (yes) Any Comments (yes)

Turning in Bed (yes) Any Comments (yes)

*Describe whether person can ask to be taken to bathroom or is totally incontinent.

C. PSYCHOLOGICAL ASSESSMENT

I. Identifying Data:

Name:Mrs. D Sex:Female

Age: Race/Ethnicity:

Marital Status: widow Children: 1 daughter

Where Employed:  Occupation (past, present):

Ever active in a different occupation?

If yes, why did you change occupations?  When?

Other members in household:

Date of admission/first contact?  Referral source?

 II. Health History

Transient ischemic attack with Hypertension as one of her co-mordities.

III. Life-Style Patterns:

n/a

IV. Perceptual Ability:

n/a

V.    Emotional Status:

● Self concept:

● Ego ideal:

● Super ego

VI. What rules or customs are difficult for you to follow?

VII. What do you consider the most important teachings that were given to you by your parents or family?

VIII. That you have lived by?

IX. What causes you to feel guilty?

X.Relations to others:

XI.Sense of autonomy:

How has aging or illness or hospitalization or admission to nursing home or residence affected your feelings of
control or lack of control?

Reaction and coping with situations:

Adaptive pattern:

What do you find best relieves your tension – eating, smoking, drinking, drubs, sleep, activity etc?
XII.    Use of Leisure:

XIII.    Communication Pattern: (Observe and listen for)

XIV.   Cognitive Status:  (Observe and listen for)