ASSESSMENT

Let’s begin in
To start the day… prayer…
Let us pray: Make the sign of the cross…
Our Father…
After understanding what is geriatric as to what is aging, the different theories and
physiologic changes affecting the older adult systems although not synonymous with
disease or disability, aging is commonly associated with an increased incidence of
chronic disease. However, disease findings may be difficult to distinguish from those
that represent normal age-related changes. What’s more, the patient commonly has a
vague symptom that aren’t clearly characteristics of a disorder. Therefore, assessing
physical and psychological function can provide key information about the patient’s
status.
For a patient of any age, a CAREFUL ASSESSMENT is the foundation of care for all
patients, regardless of age. With older patients, your assessment is particularly important
because their needs are complex. To identify the problems and needs of older adults, you
must integrate a sound theoretical knowledge of the geriatric population with your best
assessment skills.
At the end of this lesson, you will be able to:
 
Learned & understand what is assessment?
Know what are variables affecting assessment?
The tools for a functional assessment?
What are the 2 factors in performing health assessment?
How to obtain health history? What are things to prepare?
What to assess and examine in older adult patient?
How to do assessment and Physical Examination
 DIRECTION: LET’S DO ENUMERATION & FILL IN THE BLANKS
Before you proceed to the next lesson learning about health assessment to the
older adult, let us try to have a simple recall of the some of the important things in
relation to assessment.
A. Enumerate the ff:
What are the elements of the nursing process?
1.
2.
3.
4.
5.
6.

What are the basic techniques in doing physical assessment?

1.
2.
3.

Thank You for answering!

4.
 
The 2 components of nursing assessment
1.
2.
 Activity 1:
Please try to do a simple health assessment from any members of your family & extended family. Grandparents,
Aunties / Uncles if they are living in your house, your parents, and siblings -sick or not. ( Ex. like problems of
hypertension, diabetic, pneumonia, rheumatoid arthritis, acne faces, obesity, and etc. ) . Write it down in your
Journal Notebook. Just one problem only.
1. Who? write the name of the person involved
2. What is the problem?
3. Is there any existing manifestations of the problem?
4. What is your analysis of the problem?
5. What did you do?
6. After that, any sign of progress?
 
 E ssential Questions? (Do not write)
1.Wha t is a n a sse ssm e nt? why it is im p o rta nt?
2. wha t a b o ut c o nse nt? Is it im p o rta nt to o ?
Firming Up!/Deepening
DISCUSSION TIME

Now! Brace yourself OK!

 

In adapting your assessment, you may consider the following things:

o That they differ greatly from patients of other age-groups.
o Age-related changes affect individuals at different times and rates and to different degrees.
o Role transitions and psychological adjustments too.
o Aging is commonly associated with an increased incidence of chronic disease.
o Patient commonly has vague symptoms that aren’t clearly characteristic of a disorder.
o The assessment may take place in various settings.
 Another thing is that, there are variables
that affects the assessment in older adult
the followings are:
1. Setting / place
2. Time
3. Energy level and the environment.
4. Consent
5. Language or communications deficits
6. Your very own Attitude
 
 A. Va ria ble s
1. Attitud e
 Re fe rs to yo ur p e rso n a l fe e lin g s & p re jud ic e s/ b ia se s to w a rd s th e
p a tie n t.
2. Pa tie n t’s Attitud e
 Re fe rs to th e p a tie n t’s o w n p e rc e p tio n o r a ttitud e s to w a rd h is/ h e r
b o d y a nd h e a lth .
3. La n g ua g e
 Re fe rs to th e w a y h o w yo u c o m m un ic a te . The la n g ua g e yo u use
w he n yo u a sse ss a n o ld e r p a tie n t sh o uld b e ta ilo re d / fit to th a t in d ivid ua l.
Like th e e d uc a tio n a l le ve l, c ulture , a n d th e la n g ua g e s h e / sh e m a y sp e a k.
4. Deficits
 Refers to the problems/ deficits (sensory, neurologic and musculoskeletal) that
might interfere with accurate data collection such as misinterpretation of a questions
due to hearing and vison impairments, destructions due to discomfort or pain.
5. Consent
 Refers to when one person agrees to or gives permission to another person
to do something. 
 means agreeing to an action based on your knowledge of what that action involves,
its likely consequences and having the option of saying no. The absence of
no does not mean yes.
 Is an essential element for all patients to ask before doing anything (like
procedures) or something to agree upon.
 Elements of consent: what are they?
o The right to know why you’re doing the assessment
o What procedure it involves.
o What kind of information you need
o The right to refuse to answer question or to participate in any aspect of the
assessment.
6. Time and Energy level
 Refers to the allotted time and energy you give for your assessment. Considering that
there some factors that might hinder or interfere during assessment such fatigue &
discomfort of the patient ‘s side.
7. Environment
 Refers to the place where you do an assessment. It should be comfortable, quiet and
well-lit most specially to the elderly patient.
 
 
 A. Pe rfo rm ing the HEALTH ASSESSMENT

A c o m p re h e n sive h e a lth a sse ssm e n t o f a n o ld e r a d u lt in vo lve s ta kin g a

tho ro ug h he a lth histo ry a n d p e rfo rm in g a c o m p le te p hysic a l e xa m ina tio n.

1. Ob ta ining the He a lth Histo ry

- Th e h e a lth h isto ry a n d in te rvie w , is th e first p h a se o f
o f th e h e a lth a sse ssm e n t, p ro vid e a su b je c tive
a c c o u n t o f th e o ld e r a d ult’s p re se n t a n d p a st h e a lth sta tu s.
- In itia te re la tio n sh ip a n d e sta b lish th e p a tie n t’s w e ll-b e in g
a s yo u r p rim a ry c o n c e rn .
- Ke y a re a s o f fo c u s fo r p h ysic a l e xa m in a tio n .
 Preparing for the Interview
a. Timing
– a plan to talk with older patients early in the
day, when they likely to be most alert.
o “SUNDOWN SYNDROME “– a condition by which the older people
experience, the capacity for clear thinking diminishes by late afternoon
or early evening. Or even disoriented /confused later in the day.
- S/S of Sundown Syndrome during the assessment
 Fatigue, sighing, grimacing
 Head & shoulder drooping
 Irritability, slouching
 Leaning against something for support
- schedule additional times and take advantage of other interactions
to elicit additional data & validate known data
- clarify inconsistencies and possible inaccuracies by assessing the
patient more than once and at different times of the day.
b. Environment
- What to prepare?
 area that’s private, comfortable, warm enough & draft free and ample
space for if the person uses assistive devices.
 Avoid bright fluorescent lighting/ direct sunlight instead use diffused
lighting.
 Keep water /other fluids on hands
 Patients is closed to the bathroom
 Have comfortable chair available
 Encourage to change position in the chair and to move around as much
as he/she wants to during the interview.
c. Deficits
o Problem of Vision
- If the wear glass make sure he has them before the interview.
- Pull shades and block light from the patient’s view
- Reduced visual acuity or environmentally induced blindness from bright lights, shiny floors or
direct sunlight – can cause squinting /poor eye contact to patient.
- Face the patient closely at eye level.
o Hearing Impairment
- Close the door in the room—this minimizes noises of any sorts and
Destructions.
- Speak distinctively, clearly, slowly and don’t shout- but in mellow tone voice.
- Make sure the room is well- lit, so the patient can read your lips
- If the patient wears hearing aid, make sure it’s in place and working properly.
- Repeat if necessary during the interview.
 continue….
Let us

d. Communication
- Always address an older patient appropriately (Mr./Mrs. followed
by the surname)
- As per recommendation used body language, touch, shake
hand, and eye contact to encourage participation.
- Talk to the person concerned and not at him-unless otherwise
necessary or needs interpreter.
- Early in the interview try to evaluate the patient’s ability and reliability as a Historian.
Unless necessary to aid or to elicit more information from the patient. For this may
hinder the patient to speak freely.
- Provide carefully structured questions to elicit significant information.
- Ke e p yo u r q u e stio n s c o n c ise , re p h ra se th o se h e d o e sn ’t
u n d e rsta n d , a n d th o se u se n o n ve rb a l te c h n iq u e s, su c h a s fa c ia l
e xp re ssio n , p o in tin g , to u c h in g to e n h a n c e yo u r m e a n in g .
- Use te rm s a p p ro p ria te ly to th e p a tie n t le ve l o f u n d e rsta n d in g
- Avid u sin g ja rg o n a n d c o m p le x m e d ic a l te rm s
- O ffe r e xp la n a tio n in la y te rm s a n d th e n u se th e re la te d m e d ic a l
te rm s a p p ro p ria te ly fo r th e p a tie n t to fa m ilia rize .
- Ta ke a little e xtra tim e to h e lp h im u n d e rsta n d a n d se e th e
re le va n c e o f th e o f yo u r q u e stio n s.
- Re p e a t th e q u e stio n s if n e c e ssa ry
- G ive p a tie n t p le n ty o f tim e to re sp o n d to yo u r q u e stio n s a n d
d ire c tio n s
- Re m a in sile n t to a llo w h im tim e to c o lle c t h is th o u g h ts a n d id e a s
b e fo re re sp o n d in g .
e. Consent
- Initial contact should focus on ensuring that patient
knows the assessment’s purpose and how he can help
during the history taking-an impotent step in
establishing a trusting relationship.
 
 Power Booster
 

Please answer the following activities 2& 3:

 
Activity 2
When you do your initial interview, what are factors to considered as first things
to ask to your patient which serve as basic information and valuable data.
a. (What are things found in the patient information sheet) write it down.
b. What about medical history? how will you elicit the information initially?
 
 Power Booster
 

C. And for the different systems of the body & assessment, try to see the
table below and answers it too.
(The review of systems for an older person involves asking questions that keep in mind
the physiologic changes considered normal in the aging process. Now, reviewing
specific body areas and systems using either a head- to -toe approach or the major body
system method.)
Body Systems What things to ask?

1. Skin, hair and nails  

1. Eyes  
 
1. Ears and hearing  

1. Respiratory System  

1. Cardiovascular System  
 Power Booster
 

Body Systems What things to ask?

1. GI System  

1. Genitourinary System  

1. Neurologic System  

1. Musculoskeletal System  

1. Hematologic and Immune  

System
1. Psychosocial Assessment  

1. ADL Assessment  
2. Performing the PHYSICAL ASSESSMENT
- The Physical examination is the second component of the health
assessment.
- Together with the health history, it helps you identify and evaluate
the patient’s strengths, weaknesses, capabilities, and limitations.
- Use inspection, palpation, percussion, and auscultation together
objective patient data, which provide new information and help you
validate the subjective data you obtained during the health history.
Consider these things for older adults:
Because they become easily fatigued during P.E.
1. Prepare all necessary equipment with in easy reach and
proper working order
2. Anticipate the patient’s needs for modifications and
additional comfort measures as necessary.

Keep the following points in mind:

1. Respect the patient’s need for modesty. As to patient’s privacy
during examination.
2. Ensure patient’s comfort during examination.
3. Anticipate any problems with mobility /strength that might
assistance from another person.
 
How do I perform the P. E. to the patient?
What to examine? How and what to check?

A. General Survey  

1. Vital Signs  

a. Temperature
b. Pulse
c. Respirations
d. Blood pressure
e. Height & weight
B. Skin, Hair and Nails   What to check? H. Chest & Respiratory System  What to check?

I. GI System  
C. Head & Face  
J. Genitourinary System  

D. Nose & Mouth   K. Musculoskeletal System  

L. Neurologic System  
E. Eyes  
M. Cranial nerves  

F. Ears   N. Motor and Sensory Systems  

O. Hematologic and immune  

G. Neck   System
P. Endocrine System  
 Time to Reflect
Think ,think, think…

  Therefore, for a patient of any age, a CAREFUL ASSESSMENT is the

foundation of care for all patients, regardless of age. With older patients,
your assessment is particularly important because their needs are complex.
To identify the problems and needs of older adults, you must integrate a
sound theoretical knowledge of the geriatric population with your best
assessment skills.
 
Fo r y o urse lf: Assig nm e nt

1. Yo u m u st u n d e rsta n d w e ll w h a t yo u ’ve w ritte n o r a n sw e re d in th e a c tivitie s

th a t I g a ve yo u . Th is w ill h e lp a n d ke e p yo u in a rig h t tra c t to h a ve a g o o d
a sse ssm e n t skill.

2. C o n tin u e yo u r re a d in g a n d try to a ssim ila te slo w ly w h a t yo u ‘ve le a rn e d .

-To o ls fo r a fu n c tio n a l a sse ssm e n t.

3. Do n ’t fo rg e t: Alw a ys b e sm a rt, p ro m p t a nd ho ne st…

L et us pray: Make the sign of the cross…

Glory be to the Father….
Let us pray: Make the sign of the cross…
Our Father…