BACHELOR OF SCIENCE IN NURSING

NCMB 314 CARE OF THE OLDER ADULT

COURSE MODULE COURSE UNIT WEEK
1 3 3

Nursing Care of the Older Adult in Wellness (ASSESSMENT)

✔ Recite course and unit objectives

✔ Understand study guide prior to class attendance
✔ Use required learning resources; refer to unit
terminologies for jargons
✔ Proactively participate in online discussions
✔ Participate in weekly discussion board (Canvas)
✔ Answer and submit course unit tasks

At the end of the course unit (CU), learners will be able to:
Cognitive:

1. Understand 11 Basic functional Health Patterns of Older ADULT

2. Classify comprehensive geriatric assessment.
3. Describe the client’s functional level using Katz Index.
4. Explain mental status of the client using MMSE.
Affective:
1. Cooperate and listen attentively in class discussions
 3. Respect comments and opinion of other and accepts criticism

Psychomotor:
1. Evaluate nutritional status of elderly using mini nutritional assessment.
2. Participate in interactive discussion concerning dose-response relationship of drugs.

Lecturio Video: Age Related Disorders: Assessing Cognitive disorders

ASSESSMENT (potential health hazard to identify risk factors for illness and injury)
Risk Factors
o Habits
o Lifestyle patterns
o Personal and family medical history
o Environmental conditions

Functional Status Assessment

Functional status is considered a significant component of an older adult’s quality of life.

Assessing functional status has long been viewed as an essential piece of the overall clinical
evaluation of an older person. Functional status assessment is a measurement of the older
adult’s ability to perform basic self-care tasks, or ADLs, and tasks that require more complex
activities for independent living, referred to as IADLs. Determination of the degree of functional
independence in these areas can identify a client’s abilities and limitations, leading to
appropriate interventions.

The client’s situation determines the location and time when any of the scales or tools
should be administered, as well as the number of times the client may need to be tested to
enjoy to ensure accurate results. Many tools are available, but the nurse should use only those
which are valid, reliable, and relevant to the practice setting.

The Katz Index is a useful tool to describe the client’s functional level

MiniMental State Examination

Approach the patient with respect and encouragement.
Ask: Do you have any trouble with your memory? Yes No

SCORE ITEM
5( ) TIME ORIENTATION
Ask:
What is the year ________________ (1), season __________________(1),
Month of the year_______________ (1), date ____________________, (1),
Day of the week ________________ (1)

5( ) PLACE ORIENTATION
Ask: Where are we now? What is the state __________________ (1), city ________________ (1),
part of the city _________________ (1), building _________________ (1)
floor of the building _____________ (1)

3( ) REGISTRATION OF THREE WORDS

Say : Listen carefully, I am going to say three words. You say them back after I stop. Ready..Here they are-
PONY (wait 1 second), QUARTER (wait 1 second), ORANGE (wait 1 second). What were those words?
_______________________ (1)
 _______________________ (1)
_______________________ (1)
Give 1 point for each correct answer, then repeat them until the patient learns all three

5 ( ) SERIAL7s AS A TEST OF ATTENTION AND CALCULATION

Ask: Subtract 7 from 100 and continue to subtract 7 from each subsequent remainder until you stop.
What is 100 take away 7? _____________ (1)
Say:
Keep going. ________________________ (1), ____________________________ (1),
___________________________________ (1), ____________________________ (1)

3 ( ) RECALL OF THREE WORDS

Ask:
What were those three words I asked you to remember?
Give one point for each correct answer _______________________ (1),
_____________________________ (1), ________________________ (1)

2 ( ) NAMING
Ask:
What is this? (show pencil) _______________________ (1), What is this? (show watch) ____________________ (1),

1 ( ) REPETITION
Say: read the following
Now I am going to ask you to repeat what I say. Ready? No ifs, ands, or buts.
Now you say that ________________________________________ (1)

3 ( ) COMPREHENSION
Say:
Listen carefully because I am going to ask you to do something:
Take this paper in your left hand (1), fold it in half (1), and put it on the floor. (1)

1 ( ) WRITING
Say:
Please write a sentence. If patient does not respond, say: Write about weather (1)

1 ( ) READING
Say:
Please read the following and do what it says, but do not say it aloud. (1)
Close your eyes
1( ) DRAWING
Say: Please copy this design.

TOTAL SCORE ___________________________ Assess level of consciousness along a continuum

____________________________________________
Alert Drowsy Stupor Coma

YES NO YES NO FUNCTION BY PROXY

Cooperative: Deterioration from Please record date when patient was last able
Depressed: previous level of to perform the following task. Ask caregiver
Anxious: functioning: if patient independently handles:
Poor vision: Family history of Dementia: YES NO DATE
Poor hearing: Head trauma: Money/ Bills: _____________
Native Language: Stroke: Medication: _____________
_______________________ Alcohol Abuse: Transportation: _____________
Thyroid Disease: Telephone: _____________
PAR-Q AND YOU

Gordon’11 Basic functional Health Patterns of Older ADULT

1. Self-Perception/ Self-Concept Pattern

▪ This pattern encompasses a sense of personal identity;body language,
attitudes, and view of self in cognitive, physical, and affective realms; and
expressions of sense of worth and emotional state. Perceptions of self
should be explored with direct questions, asked with sensitivity. Emotional
patterns can be identified during this exploration of perceptual patterns.
o Subjective: Determine the client’s feelings about his or her
competencies and limitations, withdrawal from previous activities, self-
destructive actions, excessive grieving, and increased dependency on
others.
o Objective: Identify verbal and nonverbal cues related to the above
subjective data.

2. Roles/ Relationship Pattern

▪ This pattern encompasses the achievement of expected developmental
tasks. Basic needs for communication and interactions with other people,
as well as meaningful communications and satisfaction in relationship with
others are examined.
o Subjective: Determine family structure, history of relationships, and
social interactions with friends and acquaintances.
o Objective: Examine the family dynamics of interdependent,
dependent, and independent practices among members.

3. Health Perception/ Health Management Pattern

▪ This pattern encompasses the perceived level of health and current
management of any health problems.
 o Subjective: Determine the level of understanding of any treatments
or therapy required for management of health deficits or activities;
include assessment of performance of activities of daily living
(ADLs) and /or instrumental activities of daily living (IADLs).
o Objective: Observe for cues that indicate effective management of
deficits, including the physical environment in which th client
resides.

4. Nutritional / Metabolic Pattern

▪ This pattern encompasses evaluation of dietary and other nutrition-related
indicators.
o Subjective: Determine the older adult’s description, patterns, and
perception of food and fluid intake and adequacy for maintaining a
healthy body mass index.
o Objective: Observe general appearance and various body system
indicators of nutritional status. Note height, weight, and fit of
clothes.

5. Coping/ Stress-Tolerance Pattern

▪ This pattern encompasses the client’s reserve and capacity to resist
challenges to self-integrity, and his or her ability to manage difficult
situations.
o Subjective: Assess ways to handle big and little problems that
occur in everyday life.
o Objective: Observe for the use of coping skills and stress-reducing
techniques, and note their effectiveness.

6. Cognitive/ Perceptual Pattern

▪ This pattern encompasses self-management of pain, presence of
communication difficulties, and deficits in sensory function.
o Subjective: Inquire about difficulties with sensory function and
communication, as well as the assessment of any cognitive
changes.
o Objective: Assess usual patterns of communication, and note the
client’s ability to comprehend.

7. Value/ Belief Pattern

▪ This pattern encompasses elements of spiritual well-being that the older
adult perceives as important for a satisfactory daily living experience and
the philosophic system that helps him or her function within society.
 o Subjective: Identify the older adult’s values and beliefs about
spirituality, with a special emphasis on how this influences health
promotion behaviors.
o Objective: Determine what is important in the older adult’s life to
support coping strategies.

8. Activity/ Exercise Pattern

▪ This pattern encompasses information related to health promotion that
encourages the older adult to achieve the recommended 30 minutes daily
of physical activity on most days of the week.
o Subjective: Screen for safety related exercise and physical activity,
using screening measures such as the physical activity readiness
questionnaire (PAR-Q).
o Objective: Obtain vital signs and conduct cardiopulmonary and
musculoskeletal system assessments.

9. Rest and Sleep Pattern

▪ This pattern encompasses the sleep and rest patterns over a 24-hour
period and their effect on function.
o Subjective: Assess usual sleep patterns, including bedtime and
arousal time, quality of sleep, sleep environment, and distribution of
sleep hours within a 24 hour period.
o Objective: Have a client keep a sleep diary that includes naps and
rest periods.

10. Sexuality/ Reproductive Pattern

▪ This pattern encompasses the older adult’s behavioral expressions of
sexuality.
o Subjective: Assess client’s satisfaction or dissatisfaction with
current circumstances related to sexual function and intimacy,
including perceived satisfaction or dissatisfaction with sexuality or
sexual experiences.
o Objective: Discuss current sexual relationship. When none is
present, elicit the meaning this has for the client’s overall emotional
and physical well-being.

11. Elimination Pattern

▪ This pattern encompasses bowel and bladder excretory functions.
o Subjective: Assess lifelong elimination habits and excretory self-
care routines.
o Objective: Perform abdominal and rectal examination; external
genitalia and pelvic examination may be indicated.
Watch and Learn:

https://study.com/academy/lesson/nutrition-needs-for-older-adults.html

https://www.mdmag.com/peers-perspectives/nutrition-elderly/assessment-of-nutritional-status

https://www.youtube.com/watch?v=il76j5L4dns

Study Questions.
1. Get the physical activity, mental status and functional status of your grandparents using the “Par Q”,
“Katz Index” and MiniMental State Examination (MMSE).
(Upload your answer to canvas).

Textbooks:
Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones & Bartlett
Publishers.610.7365 G31 2010
Eliopoulos (2018). Gerontological Nursing 9th Edition.Wolters Kluwer
Meiner (2019). Gerontologic Nursing 6th Edition. ELS
Miller (2019).Nursing for Wellness in Older Adults 8th Edition . Wolters Kluwer
Touhy ( 2018). Ebersole and Hess Gerontological Nursing and Health Aging
Filit (2017). Brocklehurts Testbook of Geriatric Medicine and Gerontology
Patińo, Mary Jane. (2016). Caregiving volume 1. Manila: Rex Book Store. F 649.1 P27
2016,v.1, c1
Doenges, Marylinn E. (2002). Nursing care plans: guidelines for individualizing patient care,
6th ed. Philadelphia: F. A. Davis Company. R 610.73 D67 2002, c5
Meiner, S. E. (2007). Gerontological Nursing 3rd Edition. Quezon City. pp. 310-311, 371.
Wold, Gloria Hoffman. (2012). Basic geriatric nursing, 5th ed. MO: Elsevier.618.970231
W83 2012, c1
American Nurses Association. Nursing: Scope and Standards of Practice. 2nd ed. Silver
Spring, MD: American Nurses Association; 2010.

Websites:
www.ebscohost.com
http://mna-elderly.com
http://www.nutrition.tufts.edu/research/myplate-older-adults
Nursing Care
of Older Adult
in Wellness
NCMA 314 CARE OF OLDER
ADULTS
COURSE UNIT 3
Learning Objectives
At the end of the course unit (CU), learners will be able to:
1. Understand 11 Basic functional Health Patterns of Older ADULT
2. Classify comprehensive geriatric assessment.
3. Describe the client’s functional level using Katz Index.
4. Explain mental status of the client using MMSE.
5. Evaluate nutritional status of elderly using mini nutritional assessment.
6. Participate in interactive discussion concerning dose-response relationship of
drugs.

‹#›
 Assessment:
Assess for potential health hazard to identify
risk factors for illness and injury.
Risk Factors:
Loading…
▸ Habits
▸ Lifestyle patterns
▸ Personal and family medical history
▸ Environmental conditions
‹#›
‹#›
 Functional Status Assessment
▸ Functional status is considered a significant component of an
older adult’s quality of life.
▸ Functional status assessment is a measurement of the older
Loading…
adult’s ability to perform basic self-care tasks, or ADLs, and tasks
that require more complex activities for independent living,
referred to as IADLs.
▸ Determination of the degree of functional independence in these
areas can identify a client’s abilities and limitations, leading to
appropriate interventions.

‹#›
 Functional Status Assessment
▸ The client’s situation determines the location and time when any
of the scales or tools should be administered, as well as the
number of times the client may need to be tested to enjoy to
ensure accurate results.
▸ Many tools are available, but the nurse should use only those
which are valid, reliable, and relevant to the practice setting.

‹#›
Katz Index
The Katz Index is a
useful tool to describe
the client’s functional
level.

‹#›
MiniMental State Examination

‹#›
MiniMental State Examination

‹#›
MiniMental State Examination

‹#›
PAR-Q
AND Loading…
YOU

‹#›
 Gordon’s 11 Basic Functional
Health Patterns of Older Adult
1. Self-Perception/Self-Concept Pattern
▸ This pattern encompasses a sense of
personal identity; body language, attitudes,
and view of self in cognitive, physical, and
affective realms; and expressions of sense of
worth and emotional state.

‹#›
 Gordon’s 11 Basic Functional
Health Patterns of Older Adult
2. Roles/Relationships Pattern
▸ This pattern encompasses the achievement of
expected developmental tasks.
▸ Basic needs for communication and
interactions with other people, as well as
meaningful communications and satisfaction in
relationship with others are examined.

‹#›
 Gordon’s 11 Basic Functional
Health Patterns of Older Adult
3. Health Perception/Health Management Pattern
▸ This pattern encompasses the perceived level of
health and current management of any health
problems.

‹#›
 Gordon’s 11 Basic Functional
Health Patterns of Older Adult
4. Nutritional/Metabolic Pattern
▸ This pattern encompasses evaluation of dietary
and other nutrition-related indicators.

‹#›
 Gordon’s 11 Basic Functional
Health Patterns of Older Adult
5. Coping/Stress-Tolerance Pattern
▸ This pattern encompasses the client’s reserve
and capacity to resist challenges to self-
integrity, and his or her ability to manage
difficult situations.

‹#›
 Gordon’s 11 Basic Functional
Health Patterns of Older Adult
6. Cognitive/Perceptual Pattern
▸ This pattern encompasses self-management of
pain, presence of communication difficulties and
deficits in sensory function.

‹#›
 Gordon’s 11 Basic Functional
Health Patterns of Older Adult
7. Value/Belief Pattern
▸ This pattern encompasses elements of spiritual
well-being that older adults perceive as important
for a satisfactory daily living experience and the
philosophic system that helps him or her function
within society.

‹#›
 Gordon’s 11 Basic Functional
Health Patterns of Older Adult
8. Activity/Exercise Pattern
▸ This pattern encompasses information related to
health promotion that encourages the older adult to
achieve the recommended 30 minutes daily of
physical activity on most days of the week.

‹#›
 Gordon’s 11 Basic Functional
Health Patterns of Older Adult
9. Rest and Sleep Pattern
▸ This pattern encompasses the sleep and rest
patterns over a 24-hour period and their effect on
function.

‹#›
 Gordon’s 11 Basic Functional
Health Patterns of Older Adult
10. Sexuality/Reproductive Pattern
▸ This pattern encompasses the older adult’s
behavioral expressions of sexuality.

‹#›
 Gordon’s 11 Basic Functional
Health Patterns of Older Adult
11. Elimination Pattern
▸ This pattern encompasses bowel and bladder
excretory functions.

‹#›
 Planning
● Exploring older adults’ personal ideas and beliefs
concerning health needs
● Reading current literature regarding latest update for
specific health promotion
● Current health policy information that will safeguard
client rights
● Understanding and use of behavior change theories
 Implementation
● Adopting a proactive stance toward an action plan for health promotion of
the older individual
● Activities, locations, and means of disseminating health promotion
● Annual health promotion screening
● Program that provide vaccinations for older adult
● Screening for cancer , diabetes, and other condition
● Monthly health talks provided in senior centers
● Housing sites
● Continuing retirement communities
● Advocate and educate about health promotion
● Safe medication use
 Evaluation
● Determining effectiveness of care plan
● Check established goals
● Establish appropriate and realistic revised goals and
realistic steps to achieve them
Nursing Care
of Older Adult
in Wellness
NCMA 314 CARE OF OLDER
ADULTS
COURSE UNIT 3

THANK YOU FOR

LISTENING!
PLANNING
➢ Exploring older adults’ personal ideas and beliefs concerning health needs
➢ Reading current literature regarding latest update for specific health promotion
➢ Current health policy information that will safeguard client rights
➢ Understanding and use of behavior change theories

Implementation
➢ Adopting a proactive stance toward an action plan for health promotion of the older
individual
➢ Activities, locations, and means of disseminating health promotion
➢ Annual health promotion screening
➢ Program that provide vaccinations for older adult
➢ Screening for cancer , diabetes, and other condition
➢ Monthly health talks provided in senior centers
➢ Housing sites
➢ Continuing retirement communities
➢ Advocate and educate about health promotion
➢ Safe medication use

EVALUATION
➢ Determining effectiveness of care plan
➢ Check established goals
➢ Establish appropriate and realistic revised goals and realistic steps to achieve them

● Mini-Mental State Exam (MMSE) is a widely used test of cognitive function among the
elderly; it includes tests of orientation, attention, memory, language and visual-spatial
skills.
• Katz Index of Independence in Activities of Daily Living, commonly referred to as the
Katz ADL, is the most appropriate instrument to assess functional status as a
measurement of the client's ability to perform activities of daily living independently .
• Physical Activity Readiness Questionnaire (PAR-Q) is a common method of
uncovering health and lifestyle issues prior to an exercise programmed starting. The
questionnaire is short and easy to administer and reveals any family history of illness.