History of Old Client

In The Name of God
(A PROJECT OF NEW LIFE COLLEGE OF NURSING KARACHI)
UNIT 12 : ASSESSMENT OF
THE An Elderly Client
Shahzad Bashir
RN, BScN, DCHN, MScN (Std. DUHS)
Instructor
New Life College of Nursing
January 19, 2016
Objectives
• By the end of the unit, learners will be able to:
• Describe the common structural changes brought on by
aging in various body systems.
• Recognize the geriatric syndrome.
• Discuss the variations in history taking for an elderly
client.
• Examine elderly client by modifying examination
techniques.
• Describe assessment abnormalities in elderly clients.
• Describe how communication should be varied to
communicate with elderly clients
What is geriatric assessment?
• A geriatric assessment is a comprehensive

evaluation designed to optimize an older person's
ability to enjoy good health, improve their overall
quality of life, reduce the need for hospitalization
and/or institutionalization, and enable them to live
independently for as long as possible.
Normal Changes of Aging
• Physical changes related to “Normal” aging
ARE NOT disease
• Changes occur in most body systems to
include:
Sensory System
Brain and Central Nervous System
Muscles and Bones
Digestion
Heart/Circulatory System
Respiratory System
Cognitive Objectives (1 of 3)
1. Describe the following basics of patient

assessment for the geriatric patient:
• Scene size-up
• Initial assessment
• Focused history and physical exam
• Detailed physical exam
• Ongoing assessment
2. Discuss common chief complaints of older
patients.
3. Describe trauma assessment in older patients for
the following injuries:
• Injuries to the spine
• Head injuries
• Injuries to the pelvis
• Hip fractures
4. Describe acute illnesses in older people,
including:
• Cardiovascular emergencies
• Dyspnea
• Syncope and altered mental status
• Acute abdomen
• Septicemia and infectious disease
5. Discuss response to older patients in nursing and
skilled care facilities.
Psychomotor Objectives
6. Demonstrate the patient assessment skills that
should be used to care for an older patient.
• There are no affective objectives for this chapter.

• All objectives in this chapter are noncurriculum
objectives.
Geriatric Assessment
• Geriatric assessment has unique challenges.
• The GEMS diamond can be a helpful tool.
• Preexisting conditions may affect findings.
Scene Size-up (1 of 2)
• Be keenly aware of the environment and

why you were called.
• Scene safety should include looking for
unsafe conditions.
• Look for hazards.
– Steep stairs, missing handrails, poor
lighting, other fall hazards
Scene Size-up (2 of 2)
• The general condition of the home will provide

clues.
– Cleanliness, heat, lighting, food
• Look for signs of activities of daily living.
– Personal hygiene, getting dressed, food
preparation
• Scene size-up continues throughout call.
Initial Assessment
• Never assume altered

mental status is normal.
• May have to rely on
family or caregiver to
establish patient’s
baseline LOC
• Assess the patient’s
chief complaint and
ABCs.
• History is usually the key
in helping to assess a
patient’s problem.
• Patience and good
communication skills are
essential. Focused History and
• Treat the patient with Physical Exam (1 of 2)
respect.
• Face the patient and
speak in a normal tone.
Focused History
and Physical
Exam (2 of 2)
• Medication history
– Often have multiple medication
– Obtain a list of medications and doses.
– Ask about medications recently started or
stopped.
– Determine if the patient has taken other
medications.
Medication Use
The average geriatric patient takes four or more

medications.
Detailed and Ongoing Exams
• Normal aging may affect physical findings.

– Increased BP, respiratory changes
• Chronic changes can mask acute problems.
• Ongoing assessments will help determine changes.
– Geriatric patients have decreased ability to
compensate.
Geriatric syndrome
• The term “geriatric syndrome” is used to capture
those clinical conditions in older persons that do
not fit into discrete disease categories.
• Many of the most common conditions cared for by

geriatricians, including delirium, falls, frailty,
dizziness, syncope and urinary incontinence, are
classified as geriatric syndromes.
Common Complaints
• Dyspnea • Fever
• Chest pain • Trauma
• Altered mental • Falls
status • Generalized pain
• Dizziness or • Nausea, vomiting, and
weakness diarrhea
Trauma Assessment (1 of 2)
• Common mechanisms of injury
– Falls
– Motor vehicle trauma
– Pedestrian accidents
– Burns
Trauma Assessment (2 of 2)
• Priorities in rapid trauma are the same.
• Confounding factors:
– Medical conditions or previous injuries
– Dentures or other dental implants
– Decreased ability to compensate
– Changes associated with aging
Injuries to the Spine
• Classified as stable or
unstable
• Osteoporosis is a
contributing factor to
spinal injuries.
• Prompt spinal
immobilization can
reduce further damage
and pain.
– Pad void spaces.
Head Injuries
• Assume a significant
injury in older patients
who have signs and
symptoms of head
injury.
• Suspect brain injury in
patients who take blood
thinners and who suffer
head injury.
• Maintain oxygen
delivery to brain.
Injuries to Pelvis and
Hip Fractures
• Often present as hip or buttock pain
• Pelvic ring disruption can lead to hemorrhage or
internal organ injury.
• Hip fractures:
– Common debilitating injury
– Maintain leg in static position to prevent further
injury.
Hip Fracture
Blanket rolls maintain the leg in a static position so

that further injury does not occur.
Medical Emergencies
• Determining chief complaint is challenging.
– Multiple conditions and complaints
– Ask what bothers them most today.
• Sensation of pain may be diminished.
• Fear of hospitalization
• Conditions may present differently.
Cardiovascular Emergencies
• Classic symptoms are often not present.
• Many have “silent” heart attacks.
• Common signs and symptoms
– Difficulty breathing
– Toothache
– Arm pain
– Back pain
Dyspnea
• Related to many causes
– Asthma
– COPD
– Congestive heart failure
– Pneumonia
• Provide oxygen for all patients experiencing
dyspnea.
Syncope
• Can occur for many reasons in geriatric
patients
– Standing up too fast
– Straining to have bowel movement
– Myocardial infarction
– Diabetic shock
Altered Mental Status
• Acute onset is not normal in any patient.
• Most sudden changes are caused by a reversible
condition.
• Evaluate and treat for hypoxia or hypoglycemia if
present.
Acute Abdomen
• Complaints of abdominal pain in older patients
usually indicate a serious event.
• Nervous system response to pain is lessened.
• Consider gastrointestinal problems or abdominal
aortic aneurysm.
Septicemia
• Results from presence of microorganisms or their
toxic products in bloodstream
• Patients may present with:
– Hot, flushed appearance
– Tachycardia and tachypnea
– Hypotension
– Chills, cough
Response to Nursing and
Skilled Care Facilities
• Important information to know from staff:
– What is the patient’s chief complaint today?
– What initial problem caused the patient to be
admitted to the facility?
• Ask the staff about the patient’s overall condition.
• Obtain any type of transfer papers.
References.
• Bicklay, L. S. (1999). Bates’ guide to physical
examination and history taking (7th ed). Philadelphia:
J.B. Lippincott.
• Weber, J. & Kelley, J.(2007). Health assessment in

nursing (3rd ed). Williams & Wilkins: Lippincott.

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In The Name of God

(A PROJECT OF NEW LIFE COLLEGE OF NURSING KARACHI)

• A geriatric assessment is a comprehensive

1. Describe the following basics of patient

• There are no affective objectives for this chapter.

• Be keenly aware of the environment and

• The general condition of the home will provide

• Never assume altered

• Treat the patient with Physical Exam (1 of 2)

The average geriatric patient takes four or more

• Normal aging may affect physical findings.

• Many of the most common conditions cared for by

Blanket rolls maintain the leg in a static position so

• Weber, J. & Kelley, J.(2007). Health assessment in

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