ASSESSMENT/MANAGEMENT OF

THE ELDERLY
H.Putty
 LEARNING OUTCOMES
• By the end of this lesson, participants will be
able to
• Define nursing assessment
• Describe the steps of the nursing process
• Perform scientific assessment of the older
adult using the nursing process
DEFINITION OF NURSING ASSESSMENT

• Nursing assessment is the gathering of

information about a patient's physiological,
psychological, sociological, and spiritual
status.
 The goals of care include
• Promoting and maintaining functional status
• Helping older adults identify and use their
strengths to achieve optimal independence.
 PURPOSE OF ASSESSMENT

• Establish a database about the client’s perceived

health problems and responses to these
problems. Collection and verification of data from
two sources
 Primary source - the client
 Secondary source – medical records, family and
health professionals
• Analysis of data obtained to establish a nursing
diagnosis and develop an individualised care plan
for the old person.
 THE NURSING PROCESS
Originally a five-phase process, the nursing
process today consists of six phases:
assessment, diagnosis, outcomes identification,
planning, implementation, and evaluation.
• Assessment - It is the systematic collection of
subjective (what the client says) and objective
(what the nurse sees, hears, smells, and feels)
information from the client  
• Diagnosis -Nurses diagnose human responses to
actual or potential health problems after analyzing
and interpreting the data they collect from their
assessment.
• Planning –refers to the development of nursing
strategies that can alleviate the patient’s condition
• Implementation – perform the nursing actions
identified in the planning
• Evaluation - nurses continuously evaluate both the
client's status and the effectiveness of the client's
care. They then modify the care plan as needed.
 TYPES OF DATA
• Subjective data – client’s perception of his
health
• Objective data – measurements or
observations made by the data collector
 SOURCES OF DATA
• The client
• Family members and significant others
• Healthcare team members – physician, social worker
• Medical records – medical history, laboratory tests
and diagnostic results
• Doctor’s proposed plan of care
• Literature review – medical, nursing and
pharmacological review
• Nurse’s own experience – e.g. when in pain
 METHODS OF DATA COLLECTION
• Nursing health history
• Physical examination (vital signs /systemic
examination of the body)
• Laboratory investigation results
• Diagnostic tests results
PURPOSES OF PHYSICAL EXAMINATION

• Gather health history

• Establish a nursing diagnosis and develop a
comprehensive care plan
• Manage client’s problems
• Evaluate nursing care
 DEFINITION OF NURSING DIAGNOSIS

• It is the clinical judgment about actual or

potential individual, family or community
responses to health problems or life
processes.
• It provides the basis for selection of nursing
interventions to achieve outcomes for which
the nurse has accountability
 ASSESSMENT GUIDE
 Respiratory function – patient complains of
fatigue and breathlessness with sustained
activity, difficulty in coughing up secretions
Nurse’s action:
• General observations
• Interview
• Physical examination
 CARDIOVASCULAR FUNCTIION
 General observation
• Skin color
• Energy level
• Breathing pattern
• Condition of nails
• Status of vessels
• Hair on extremities- hair on extremities can accompany
poor circulation
• Oedema
• Mental status
 Interview
• Must include a review of function-any
difficulty noted in physical or mental functions
• Signs and symptoms – cold or numb arms or
legs, dark spots on legs, one leg larger than
the other
• Lifestyle practices- type of exercises
performed or pattern of alcohol consumption
 Physical examination
• Inspect patient from head to toe
• Assessment of apical and radial pulses
• Assessment of blood pressure in standing, sitting
or lying positions
• Auscultate heart
• Palpate pulses bilaterally
• Signs of phlebitis
• Discoloration of legs, oedema, lesions,
tortuous-looking veins etc.
• Skin temperature in various areas
• Make sure patient has a recent ECG, blood
screening for CRP
• Mental status –provides useful information
about circulatory problems
 GASTROINTESTINAL FUNCTION
 General observations
• General appearance
• Odors - halitosis
• Skin – dehydration; scaling, itching- nutritional deficiency
 Interview
• Status of teeth or dentures
• Taste and appetite
• Symptoms –difficult swallowing, bleeding from mouth, constipation etc.
• Weight
• Digestion
• Elimination
• Diet
• Physical examination –
• Perform a systematic examination of the lips,
oral cavity, tongue, pharynx and abdomen
 URINARY FUNCTION
 Interview
• Frequency of voiding, continence, retention, pain and
urine (crystals or particles in urine)
 Physical examination
• Inspect, and palpate the abdomen for bladder fullness,
pain or abnormalities
• Test women for stress incontinence
 Examination of urine sample- glucose, protein, note the
color and odor (strong odor-dehydration or ammonia-
like odor- infections)
 REPRODUCTIVE SYSTEM HEALTH
 Interview –
• Pain –lower abdomen, any tenderness,
discomfort, along genital area
• Secretions – blood or other discharge
• Sexual dysfunction- problem with ejaculation,
bleeding following intercourse
 Physical examination
• Genitalia for lesions, sores, breaks etc.
• Any mammogram, gynaecologic examination,
prostate examination within past year
• Breasts palpation for females
 MOVEMENT
 General observation
• Abnormal gait, abnormality of structure,
dysfunction of a limb, tremor, paralysis,
weakness, atrophy of a limb, redness and
swelling of a joint, and use of a cane, walker or
wheelchair
 Interview
• Proceed from head to toe and question patient
about limited function or discomfort in specific
parts of the body
• Make specific inquiry into how patient manages
musculoskeletal pain particularly in regard to
the use of analgesics, heat and topical
preparations
 NEUROLOGIC FUNCTION
 General observations and interview
• Observe for asymmetry, deformity, weakness,
paralysis and other abnormalities
• Symptoms of neurologic disorders- tingling
sensations, pain, numbness, blackouts, headaches,
twitching, seizures, dizziness, distortions of reality,
weakness and changes in mental status
• If clinical abnormalities or symptoms identified
inquire into their origin, length of time present and
resulting limitations or problems
 Speech assessment
• Differentiate between dysarthria (problems with
articulation) and dysphasia (language disorder marked
by deficiency in the generation of speech, and
sometimes also in its comprehension, due to brain
disease or damage).
 Physical examination
• For sensation (close eyes and describe sensations felt)
• Coordination and cerebellar function
 Reflexes –test corneal reflex with a wisp of cotton
• Babinski’s reflex
 SENSATION
 General observations
• Signs of hearing deficits
• Identify eye problems
• Foul odours that do not seem to bother the
patient
 Interview
• Date and type of last ophthalmic and
audiometric examinations, hearing aids used, any
change of vision, pain or itching eyes, any change
in ability to hear etc.
• Physical examination
• Unusual structure, drooping eyelids, any lesion or
restriction in visual fields
• Inspection of ears- any ulcerated lesion on the
pinna, evaluate hearing by evaluating the
patient’s ability to hear a watch
 ENDOCRINE FUNCTION
• Early diagnosis of diabetes in older persons is often
difficult
• Classic symptoms may be absent. Some indications
include orthostatic hypotension, periodontal
disease, stroke, impotence, neuropathy, confusion,
glaucoma and infection
• Enquire about any confusion, abnormal behaviour,
altered sleep, nocturnal headache and slurred
speech
 INTEGUMENTARY FUNCTION
 General observations
• Evaluate skin colour, moisture and cleanliness, hair
condition and grooming, condition of the nails and signs
of pallor and flushing
 Interview
• Any itching, burning sensations on the skin surface, hair
loss, increased fragility of nails
 Physical examination
• Skin surface, lesions, Mongolian spots, skin elasticity,
pressure tolerance and temperature
 IMMUNE FUNCTION
• Enquire about patient’s response to infections (repeated
attacks)
• Assess dietary intake e.g. foods that positively affect
such as milk, yogurt, eggs, fresh fruits and vegetables,
nuts, garlic, onion, sprouts, pure honey
• Any regular physical activity
• General immunisation that is recommended to older
persons unless contraindicated
• Any stress management technique
• Any overuse or misuse of antibiotics
THANK YOU