Advanced Physical Assessment Paper

Accurate, appropriate, and timely assessment by nurses is the cornerstone of high-quality care services and patient safety. According to Lee et al. (2019), advanced physical assessment equips nurses with skills such as palpation, auscultation, and percussion and allow them to handle complex patient situations. Physical examinations enable healthcare providers to evaluate a person’s overall wellness, identify any existing abnormalities, and initiate early treatment. In this essay, the author conducts an advanced physical assessment on a geriatric patient and discusses expectations for physical and developmental milestones of the patient. Further, the author describes how they would conduct a wellness exam for this patient and how they would communicate the results to the patient and his family members. A mental health assessment, anticipatory guidance, and the type of documentation produced are included. Advanced Physical Assessment Paper.

Patient Selected

Geriatric patient X

Age: 71

Gender: Male

Expectations for Physical and Developmental Milestones of the Identified Patient

Physical Milestones

Patient X is in late adulthood, the stage of life experienced by persons over the age of 60. It constitutes the last stage of physical development. According to Alvis and Hughes (2015), physical changes are highly noticeable in persons in late adulthood. For patient X, it is expected that his skin will continue to lose elasticity as his muscle strength continues to diminish. Wrinkles appear on the skin, which tends to be thinner. As small blood vessels break beneath the skins surface, spots and wart may appear on the skin. Hair also thins and continues to turn grey as height lessens due to decreased bone density. Hearing and vision for the selected patient are expected to decline significantly, and cataracts become more frequent. Other tastes such as smell and taste become less sensitive, and the patient’s immune system weakens, rendering him more susceptible to chronic illness.  The decline in sensations could be attributed to medications such as antihypertensives and other physical effects of aging (Alvis & Hughes, 2015).  At this age, respiratory and cardiovascular problems become common. Patient X is expected to experience a decrease in physical mobility and balance, positioning him at a high risk of falls and other related injuries.  In addition to appearance changes and dulling of sensations, individuals over the age of 70 experience a significant reduction in reflexes and fine motor capabilities which worsen with advanced age. At the age of 71, patient X is expected to experience a gradual decrease in his response to spontaneous events.

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Developmental Milestones

Among the developmental milestones of patients over the age of 70 are reduced brain functioning, memory loss, and diminished intellectual functioning. According to research, memory degenerates with age, and older adults experience difficulties remembering and attending to information (Martínez-Maldonado et al., 2016). While patient X’s procedural memory is expected to remain constant, his working memory is expected to decline. A general memory decline is highly attributed to reduced encoding, storage, and retrieval speed. Diminished memory is linked to conditions such as dementia and Alzheimer’s disease, which are highly common among the elderly population. In late adulthood, socio-emotional development also declines as individuals become more dependent.

How to Conduct a Wellness Exam for this Patient as an Advanced Practice Nurse

A wellness exam for the geriatric population encompasses physical and functional assessment.

Physical Assessment

Advanced practice nurses should conduct a physical examination by focusing on domains such as mobility, falls, sensory functioning, pain, and bladder functioning (Jiang & Li, 2016). Abnormality in any of these domains can negatively alter the patient’s physical functioning. To assess the patient’s mobility, an advanced practice nurse should ask both the patient and the caregiver on the number of falls within the past year. Advanced Physical Assessment Paper.  The Timed up and Go (TUG) test should be used to assess patient X’s mobility.  Impaired balance among the elderly presents in the form of falls, which are highly prevalent in patients over the age of 70.  The advanced practice nurse should utilize the Tinetti Balance and Gait Evaluation tools to assess to balance and risk of falls.

Sensory Functioning

Screening for hearing and vision problems among the elderly is crucial (Wittich et al., 2018). Advanced practice nurses should use the Snellen chart to screen elderly patients for visual acuity. Additionally, nurses should periodically question older patients on their hearing. It is also recommended that they conduct audioscope examination, otoscopic examination, and the whispered voice test. Identifying hearing impairments is essential to prevent health conditions such as presbycusis.

Bladder Functioning

Also known as urinary continence, effective bladder functioning is vital in improving seniors health. Incontinence, the unintentional leakage of urine, affects over 15 million elderly persons in the United States. It is linked to numerous medical repercussions, including decubitus ulcers, sepsis, renal failure, and high mortality rates. Other psychosocial implications of urinary incontinence are reduced self-esteem and depression. Advanced practice nurses should assess urinary incontinence by evaluating patient X’s fluid intake, current medications, cognitive that nurses should ask elderly patients when assessing for urinary incontinence, is whether they feel a strong and sudden urge to void that makes him leak before reaching the toilet. To determine stress incontinence, the nurse should also ask the patient whether incontinence results from coughing, lifting, or sneezing.

Pain

The elderly populations often suffer from painful chronic and acute infections, and assessing the severity of pain among this population is a crucial role for advanced practice nurses (Booker & Herr, 2016).  Nurses should regularly assess elderly patients for pain and conditions attributable to pain management. Patient X self-reports for pain should be the most accurate and reliable measure that advanced practice nurses should rely on to measure its severity. Additional tools for quantifying the patient’s pain intensity include numeric rating scales, verbal descriptor scales, and faces pain scales.

Functional Assessment

For patient X, a functional assessment would evaluate his capability to perform activities of daily living (ADLs). Here, advanced practice nurses should focus on activities such as eating, bathing, dressing, transfers between bed and a chair, toiletry, bladder and bowel movements, medication administration, housework, managing finances, and telephone use (Devi, 2018).  Advanced practice nurses can obtain useful functional information of the patient by observing older patients complete daily tasks. Instruments such as the Katz and Lawton indexes help get information on the patient’s capacity to perform these functions independently. Here, nurses should determine whether patient X performs these activities alone and without supervision. Deficiencies in performing daily living activities signal the need for an in-depth assessment of the patient socio-environmental settings and the necessity for additional assistance.

How Advanced Practice Nurses would Communicate Examination Results to the Patient and Family Members

When communicating the results of wellness examination to geriatric patient X, advanced practice nurses must allow extra time for the patient. Research shows that elderly patients receive less information from healthcare professionals as they tend to lose focus and are anxious. Advanced Physical Assessment Paper. Creating additional time for these patients will ensure that the patients do not feel rushed. Respect should also be embodied while communicating with seniors (Hafskjold et al., 2015). Some seniors require assistance out of the assessment room due to fatigue. Engaging their families or caregivers is, therefore, an integral approach that advanced nurse practitioners should consider. During the communication process, nurses must take into consideration the literacy level of the patient and tailor the results to the patient’s understanding. Being aware of the patient’s cultural and linguistic background will improve the communication process and communicate in a manner that its respective to the patient’s cultural and linguistic preferences.

Additionally, advanced practice nurses would communicate clearly and accurately to the patient, their family or the caregiver, and explain why they are collecting patient information and its significance in the patient’s care plan. According to Chesser et al. (2016), nurses should also ensure that the patient understands his health status and recommend appropriate actions and treatment options. After passing health information to the patient, his family, and caregivers, nurses should screen the patient’s family and carers for stress and recommend inpatient and outpatient support services. Also, it would be imperative to inquire from patient X what matters to them and how they would like to proceed.

Mental Health Assessment

For geriatric patient X, a mental wellness exam should incorporate domains such as appearance and hygiene, speech, motor movement, mood, perception, thought process, and content. During a cognitive assessment, advance practice nurse should inquire about any existing medical or psychiatrist symptoms and document them. Among older populations, some chronic health conditions have symptoms that mimic those of mental diseases (Abrams et al., 2015).  Some medications also have depressive side effects. Inquiring on the patient’s list of current medications will allow the advanced practice nurse to distinguish between the causes of depressive symptoms. The nurse should ask simple open-ended ended questions on the patient’s social and spiritual life.

Notably, screening tools are available to assess geriatric patients’ mental health status. However, advanced practice nurses only use these tools after establishing rapport with the patient. These include Geriatric Depression Scale (GDS) short version, Confusion Assessment Method (CAM) short version, Mini Mental State Examination (MMSE), and the Michigan Alcohol Screening Test Short Form (Geriatric Version)(SMAST-G).  Using these tools, advanced practice nurses should assess the four common mental health adults; depression, delirium, dementia, and alcohol and substance abuse. Advanced Physical Assessment Paper.

Anticipatory Guidance

By definition, anticipatory guidance is proactive counselling which addresses essential physical, mental, and developmental changes (Hildreth & Church, 2015).  As primary care providers, advanced practice nurses should incorporate mental health assessments using standardized, evidence-based assessment tools in each patient visit. If patient X displays symptoms of mental diseases, advanced practice nurses should refer him to appropriate testing, therapy, and counselling. They should also consider the inclusion of family members in the referral plans to offer support.

Type of Documentation Produced

Advanced practice nurses should document the information obtained from an advanced physical assessment of patient X into electronic health records, which would serve as the baseline for future comparison by all health professionals.

Conclusion

In summary, this essay centred on the advanced physical and functional assessment of patient X, a geriatric patient aged 71. It discussed the expectations for the patient’s physical and developmental milestones. It found out that the patient is likely to have physical changes such as loss of skin elasticity, grey hair, imbalance, sensory decline, cognitive decline, and memory losses. Conducting a wellness exam for patient X should focus on physical and functional assessments. Notably, the results of these exams should be communicated respectively, and advanced practice nurses should consider the patient’s literacy level, cultural, and linguistic elements during the communication process. Engaging the patient’s family or caregivers in the process is also essential. Advanced Physical Assessment Paper.

References

Abrams, R. C., Reid, M. C., Adelman, R. D., Breckman, R., Goralewicz, R., Palombo, M., Stern, A., Shengelia, R., & Teresi, J. (2015). Psychiatric assessment and screening for the elderly in primary care: Design, implementation, and preliminary results. Journal of Geriatrics, 2015, 1-9. https://doi.org/10.1155/2015/792043

Alvis, B. D., & Hughes, C. G. (2015). Physiology considerations in geriatric patients. Anesthesiology Clinics, 33(3), 447-456. https://doi.org/10.1016/j.anclin.2015.05.003

Booker, S. Q., & Herr, K. A. (2016). Assessment and measurement of pain in adults in later life. Clinics in Geriatric Medicine, 32(4), 677-692. https://doi.org/10.1016/j.cger.2016.06.012

Chesser, A. K., Keene Woods, N., Smothers, K., & Rogers, N. (2016). Health literacy and older adults. Gerontology and Geriatric Medicine, 2, 233372141663049. https://doi.org/10.1177/2333721416630492

Devi, J. (2018). The scales of functional assessment of activities of daily living in geriatrics. Age and Ageing, 47(4), 500-502. https://doi.org/10.1093/ageing/afy050

Hafskjold, L., Sundler, A. J., Holmstrom, I. K., Sundling, V., Van Dulmen, S., & Eide, H. (2015). A cross-sectional study on person-centred communication in the care of older people: The COMHOME study protocol. BMJ Open, 5(4), e007864-e007864. Advanced Physical Assessment Paper. https://doi.org/10.1136/bmjopen-2015-007864

Hildreth, K. L., & Church, S. (2015). Evaluation and management of the elderly patient presenting with cognitive complaints. Medical Clinics of North America, 99(2), 311-335. https://doi.org/10.1016/j.mcna.2014.11.006

Jiang, S., & Li, P. (2016). Current development in elderly comprehensive assessment and research methods. BioMed Research International, 2016, 1-10. https://doi.org/10.1155/2016/3528248

Lee, H., Lee, Y. J., Lee, J., & Kim, S. (2019). Physical examination competence as a predictor of diagnostic reasoning among new advanced practice nurse students: A cross-sectional study. Contemporary Nurse, 55(4-5), 360-368. https://doi.org/10.1080/10376178.2019.1670707

Martínez-Maldonado, M. D., Vivaldo-Martínez, M., & Mendoza-Núñez, V. M. (2016). Comprehensive gerontological development. Gerontology and Geriatric Medicine, 2, 233372141666784. https://doi.org/10.1177/2333721416667842

Wittich, W., Höbler, F., Jarry, J., & McGilton, K. S. (2018). Recommendations for successful sensory screening in older adults with dementia in long-term care: A qualitative environmental scan of Canadian specialists. BMJ Open, 8(1), e019451. https://doi.org/10.1136/bmjopen-2017-019451

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Action Items

1. Select an age range of patient to focus on, either a pediatric patient (0-11 years of age) or geriatric patient (greater than 70 years of age). Next, select a specific age within the range you have chosen. Also, identify the gender of the patient as appropriate.
2. Discuss expectations for physical and developmental milestones for the age of patient you have identified.
3. Discuss how you should conduct a wellness exam for this patient (physical and functional assessment) as an advanced practice nurse. Advanced Physical Assessment Paper.
4. Explain how you, as an advanced practice nurse, would communicate the results of the exam to the patient and family member(s).
5. Include mental health assessment, anticipatory guidance, and the type of documentation you would produce.
6. Your paper should be 7 pages in length, use APA style throughout, and include a minimum of 8 references that are current within the last 5 years; clinical guidelines, Bright Futures, Healthy People 2020, Medicaid, and any other relevant sources.

Assignment Rubric

1. The student researched and discussed expectations for physical and developmental milestones for the age of patient identified. The work was very accurate, detailed, and underscored the most important expectations and milestones.
2. The student discussed how to conduct a wellness exam for the patient identified. The description was accurate, detailed, and underscored the most important expectations for the exam. The student also identified three or more concepts or principles for advanced practice and how to apply them in this situation in a way to very clearly and accurately distinguish advanced practice from regular practice.
3. The student explained how, as an advanced practice nurse, they would communicate the results of the exam to the patient and family member(s). The explanation was very detailed and underscored the most important items to communicate and how to communicate them. The student also identified three or more concepts or principles for advanced practice and how to apply them in this situation in a way to distinguish advanced practice from regular practice. Advanced Physical Assessment Paper.
4. The student included mental health assessment, anticipatory guidance, and the type of documentation they would produce for the age of patient identified. The work was very accurate, detailed, and underscored the most important items of assessment and documentation. The student also identified three or more concepts or principles for advanced practice and how to apply them in this situation in a way to distinguish advanced practice from regular practice.
5. Statements were appropriately supported by APA style in-text citations to course or outside scholarly works and followed by bibliographic references. The paper contained no errors in grammar, mechanics, or spelling. The message was effectively supported and enhanced through the use of very effective organization, flow, and presentation techniques. The student met the page minimum while giving detail to communicate findings while avoiding excessive wordiness. Advanced Physical Assessment Paper.