• . Respond to at least two posts by the end of the week.

POST 1: Dana posted Aug 18, 2022 2:51 AM

 

Question 1: What questions should you ask the patient/ family to further assess?

Older adults are fragile, and hence physician should be sensitive to the kind of questions they ask when assessing them. A thorough geriatric health history is important to compile significant information related to the patient’s chief complaint. This patient’s chief complaint include unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity. In assessing this patient, I would start by asking questions such as how many times does he eat in a day, what do the meals mainly consist of, as well as whether he is able to make his own food or able to feed himself. Also, I would consider asking this patient whether there is any illness or conditions that might change the food he eats, and whether he has enough money to buy food. Besides, asking whether he eats alone or with someone else, as well as asking whether he is having any gastrointestinal issues such as nausea, vomiting, or diarrhea would have been important to lead the correct differential diagnoses. Many things such as lean body mass, slower metabolism and increased body fat are known to cause nutritional changes in older adults (Tilly, 2017). Social factors are significant contributors to unintentional weight loss. NSG 6420 South University Online Nursing Discussion

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Question 2: What screening tools would be appropriate in this case?

Considering this patient’s symptoms of frailty and weakness, one tool that can be used to assess his functionality is the SPICE tool for geriatric syndrome. The SPICE tool is used to assess for patient’s sleep disturbances, problems with eating and feeding, confusion, evidence of falls, and skin breakdown (Fulmer et al., 2019). To further assess his frailty level, a screening tool known as FRAX (Fracture Risk Assessment Tool) can be used to estimate his probability of incurring hip or other major osteoporotic fracture (Whitlock et al., 2019). Also, nutrition screening tools such as the Malnutrition Universal Screening Tool (MUST) and the Malnutrition Screening Tool (MST) would be appropriate to assess his malnutrition risk (Dent et al., 2019). Other screening tools appropriate for this patient include BMP, liver function tests, thyroid function tests and glucose measurement.

Question 3: Do you have concerns with frailty in this patient? If so, why?

My concerns for this patient are mainly related to his frailty symptoms of unintended weight loss, self-reported exhaustion, weakness, slow-walking speed, and low physical activity. Due to these symptoms, my concern is that he may be at high risk for infection and declining health because his immune system does not work that well. Even the simplest type of infection has the potential to cause harm or death of the patient.

Question 4: What referrals should be made, if any, on this patient?

Referrals would be necessary for this patient, even if the laboratory test showed no signs of progressive illness. The first would be referral to dietician to help him with his eating. A dietician would help this patient come up with a plan to regain and maintain his weight, as well as improve his overall nutritional status. Patients who report unintentional weight loss need more calories, proteins and other nutrients. Also, referring this patient to a therapist or a counselor would be appropriate to establish whether the signs of malnutrition are related to depression. Malnutrition and depression have been found to closely link (Wei et al., 2018). Patient who are malnourished due to bad eating habits are likely to end to being depressed. t him at risk for dehydration, falls, mental status changes, metabolic disturbances and muscle wasting (Dunphy, 2017). NSG 6420 South University Online Nursing Discussion

What referrals should be made, if any, on this patient?

A consultation with the dietitian or nutritionist would assist this patient and depending on what diagnostic test, labs and studies show, would determine if any further referrals are needed. Consultation for depression, malignancy, and or physical and or occupational therapy may also assist this patient depending on diagnostic findings.

References

Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2017). Primary care: The art and science of advanced practice nursing with Davis Edge (5th ed.). F. A. Davis. ISBN: 9780803667181

Kennedy-Malone, L., Fletcher, K. & Martin-Plank, L. (2018). Advanced practice nursing in the care of older adults (2nd ed.). F.A. Davis. ISBN: 9780803666610

POST 2: Daimel posted Aug 18, 2022 4:52 PM

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What questions should you as the patient/family ask to further assess?

The questions I would ask this patient/family are when did these symptoms start, his level of orientation, is he recovering from an illness, any fever chills or malaise, is he depressed, in pain or are there any sentinel events such as a death of a loved one? Is he experiencing any changes in taste, smell or having difficulty swallowing or chewing? What other symptoms has he noticed or is he experiencing any gastrointestinal disturbances such as reflux, nausea, vomiting, diarrhea or constipation. Is he capable of preparing meals, what are his sleep habits, diet, use of alcohol, tobacco, recreational drugs and if he uses herbal remedies? Lastly I would ask if he has been without food due to any financial hardship or situation? NSG 6420 South University Online Nursing Discussion

What screening tools would be appropriate in this case?

The screening tools that would be appropriate in this case would be a head-to-toe assessment- assessing his sense of smell, taste, his ability to swallow and chew, his teeth and tongue should be assessed for caries and lesions and an assessment of his abdomen, GI, GU, and musculoskeletal system would assist in ruling out differential diagnoses. I would use screening tools such as the mini mental status test to assess for dementia, assess for depression and pain, use the functional assessment and FRAIL tool and would order laboratory tests to assess for metabolic or pathologic disease processes (Kennedy-Malone, 2018).

Do you have concerns with frailty in this patient? If so, why?

Yes, I have issues with frailty with this patient because lack of nutritious meals and fluids can lead to muscle wasting, electrolyte imbalances, and nutritional deficits that can put him at risk for dehydration, falls, mental status changes, metabolic disturbances and muscle wasting (Dunphy, 2017).

What referrals should be made, if any, on this patient?

A consultation with the dietitian or nutritionist would assist this patient and depending on what diagnostic test, labs and studies show, would determine if any further referrals are needed. Consultation for depression, malignancy, and or physical and or occupational therapy may also assist this patient depending on diagnostic findings. NSG 6420 South University Online Nursing Discussion