Assessment Type
A comprehensive assessment is more appropriate for Carmelita due to her complex social and medical history and current symptoms and presentation. A comprehensive assessment will enable the nurses to evaluate Carmelita’s complete health status, including her physical, mental, lifestyle, and socioeconomic condition. A comprehensive assessment is necessary for Carmelita to determine the underlying cause of the fall and confusion. Moreover, a comprehensive assessment is essential to develop a care plan that considers her medical, emotional, and social needs. The comprehensive assessment should include reviewing her medical history, neurological examination, and respiratory status (Facchinetti et al., 2020). In addition, an ongoing assessment is necessary to continuously monitor Carmelita’s response to treatment and identify any changes in her condition. Ongoing assessment will enable regular monitoring of Carmelita’s vital signs, neurological status, respiratory status, and social and emotional status. Ongoing assessment will guide ongoing care and treatment decisions (Sjöberg et al., 2021).
Subjective Assessment Data
Other than forgetting where she put things and sometimes forgetting the children’s names, there are more subjective data that is important to obtain from Carmelita and Laurel. First, it is essential to ask Carmelita about her current symptoms, including dizziness, headaches, or other neurological symptoms (del-Pino-Casado et al., 2018). Laurel can provide additional information on changes in her mother’s personality, behavior, or cognitive function. Pain assessment is the second subjective data, including Carmelita’s pain level and location. Third is medication history, which will assess whether Carmelita is taking any medication that can impact her cardiovascular health, cognitive function, or respiratory status. Social history assessment will provide important information about Carmelita’s support systems, living situation, and level of independence. A family history assessment will provide information on genetic predisposition to specific health conditions. Finally, nutritional status will provide important information on Carmelita’s dietary intake (Şahin et al., 2019).
Objective Assessment Data
A neurological assessment is a nursing assessment that is necessary for Carmelita at this time. The physical examination of the neurological system entails assessing the peripheral and central nervous systems. It includes assessing the patient’s alertness, cognition, focal cortical functioning, thought content, mood, and affect. A neurological assessment is required to determine any deficits contributing to the patient’s unobserved fall and forgetfulness of basic details. A neurological assessment will provide objective data to assess Carmelita’s motor, cognitive, and sensory functions. Objective assessment of Carmelita’s overall neurological status will include observing her general appearance, personal hygiene, walking ability, and posture in the first few minutes of interaction. The level of orientation will be assessed using standardized tools to evaluate mental status, for example, the Mini-Mental State Exam (MMSE). The nurse will additionally assess Carmelita’s cerebellar function by observing her gait and balance (Lavedán et al., 2018).
An objective respiratory assessment will include examining Carmelita’s breathing pattern and interpreting her vital signs. The respiratory objective assessment will also include an inspection of the patient’s skin color, auscultation of lung sounds using a stethoscope, and palpation to identify abnormalities. The objective data obtained should be assessed considering what is expected of the patient’s age, development, gender, culture, environmental factors, and current health condition to determine the meaning of the data collected. Because the oxygen saturation level is less than 95%, Carmelita’s respiration is compromised and requires follow-up. The patient has a history of chronic obstructive pulmonary disease (COPD), meaning she will exhibit below-normal oxygen saturation. Therefore, it is crucial to identify trends and deviations from the patient’s baseline normal. Changes in the respiratory rate, which for adults is 12-20 breaths per minute, should be recognized to ensure the best possible outcome. The critical conditions to report immediately include decreased oxygen saturation below 92%, pain, worsening dyspnea, decreased level of consciousness, restlessness, and irritability or anxiousness (Ellis et al., 2017).
An objective cardiovascular assessment entails the interpretation of the patient’s vital signs and palpation, auscultation, and inspection of the heart sounds during evaluation for sufficient perfusion and cardiac output (Ellis et al., 2017). Carmelita’s blood pressure (BP) is 175/95, while her pulse rate is 98. Because the systolic blood pressure is more than 100 and the pulse rate is not less than 60 or greater than 100, there is no need for immediate follow-up. In older adults, such as Carmelita, there is a high likelihood of irregular heart rhythms and extra sounds. The critical conditions to report immediately include symptomatic tachycardia at rest (HR> 100 bpm), symptomatic bradycardia (HR˂ 60 bpm), new systolic blood pressure (˂100 mmHg), changes in orthostatic blood pressure, new irregular heart rhythm, new abnormal cardiac rhythm changes, new extra heart sounds, and reported chest pain, calf pain, or worsening shortness of breath.
Challenges to Assessment and Person-Centered Care
Person-centered care recognizes individual patients’ uniqueness, preferences, experiences, and needs. However, the person-centered approach can be challenging, especially when we are dealing with an older adult with complex health needs. The first challenge is language and cultural barriers. Carmelita now primarily speaks Filipino, although she understands English, which can create communication barriers to gathering accurate information resulting in difficulties in understanding her cultural background and preferences. Another challenge is cognitive impairments, as Carmelita has reported forgetfulness and confusion. The cognitive impairments can impede her ability to understand and communicate her needs effectively. The final challenge likely to be experienced in rendering person-centered care for Carmelita is physical limitations due to her recent fall, exacerbation of her COPD, and other health problems that may impede her ability to participate in assessments (Sheikh et al., 2021).
Several strategies are recommended to address these challenges to conduct nursing assessments that utilize a person-centered approach. The first strategy is utilizing a professional interpreter to facilitate effective communication with the patient to ensure her cultural background and preferences are understood and respected. The second strategy is ensuring a conducive environment, allocating sufficient time to explain procedures, and utilizing clear, straightforward terms to enhance comprehension. The third strategy is using person-centered approaches to care, for example, involving Carmelita in decision-making, identifying her goals and preferences, and personalizing care to Carmelita’s individual needs. The fourth strategy involves Carmelita’s family and caregivers to ensure coordination and alignment of her care to her goals and preferences. The final strategy identified is utilizing adaptive equipment and strategies, such as conducting assessments in stages, allocating sufficient time for assessments, and providing the needed physical support. In summary, addressing the challenges to ensure person-centered care requires a collaborative and individualized approach that recognizes Carmelita’s unique needs, preferences, and experiences (Jensen et al., 2021).
References
del-Pino-Casado, R., Frías-Osuna, A., Palomino-Moral, P. A., Ruzafa-Martínez, M., & Ramos-Morcillo, A. J. (2018). Social support and subjective burden in caregivers of adults and older adults: A meta-analysis. PloS one, 13(1), e0189874.
Ellis, G., Gardner, M., Tsiachristas, A., Langhorne, P., Burke, O., Harwood, R. H., … & Shepperd, S. (2017). Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database of systematic reviews, (9).
Facchinetti, G., D’Angelo, D., Piredda, M., Petitti, T., Matarese, M., Oliveti, A., & De Marinis, M. G. (2020). Continuity of care interventions for preventing hospital readmission of older people with chronic diseases: A meta-analysis. International journal of nursing studies, 101, 103396.
Jensen, A. N., Andersen, O., Gamst-Jensen, H., & Kristiansen, M. (2021). Opportunities and Challenges for Early Person-Centered Care for Older Patients in Emergency Settings. International journal of environmental research and public health, 18(23), 12526.
Lavedán, A., Viladrosa, M., Jürschik, P., Botigué, T., Nuín, C., Masot, O., & Lavedán, R. (2018). Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both? PLoS one, 13(3), e0194967.
Şahin, D. S., Özer, Ö., & Yanardağ, M. Z. (2019). Perceived social support, quality of life, and satisfaction with life in elderly people. Educational Gerontology, 45(1), 69-77.
Sheikh, F., Brandt, N., Vinh, D., & Elon, R. D. (2021). Management of chronic pain in nursing homes: navigating challenges to improve person-centered care. Journal of the American Medical Directors Association, 22(6), 1199–1205.
Sjöberg, M., Edberg, A. K., Rasmussen, B. H., & Beck, I. (2021). Documentation of older people’s end-of-life care in the context of specialized palliative care: a retrospective review of patient records. BMC Palliative Care, 20(1), 91.
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