Geriatric Patient

Sample Solution

This week's clinical experience focused on geriatric care, specifically with a patient presenting with altered mental status and falls. It was a challenging yet rewarding experience, offering valuable insights into the complexities of geriatric assessment and management.

Clinical Experience Overview:

I encountered an 82-year-old female patient, Mrs. A, admitted to the geriatric unit from an assisted living facility. Her presenting complaint was a recent history of multiple falls and progressive confusion over the past few days. The patient’s daughter reported that Mrs. A had become increasingly disoriented, had difficulty recognizing family members, and had experienced three falls within the last week. Her past medical history included hypertension, type 2 diabetes, and osteoarthritis.

Challenges and Successes:

One of the main challenges was differentiating between acute delirium and chronic cognitive decline. Mrs. A’s baseline cognitive status was difficult to ascertain due to the acute changes and the limited information from the assisted living facility. However, I was successful in establishing rapport with the patient's daughter, who provided valuable information about Mrs. A’s typical behavior and cognitive function. This highlights the importance of family involvement in geriatric assessments.

Full Answer Section

Patient Assessment:

• Signs and Symptoms (S&S):
  • Altered mental status (confusion, disorientation)
  • History of multiple falls
  • Impaired gait and balance
  • Mild dehydration (dry mucous membranes)
  • Elevated blood pressure (160/90 mmHg)
  • Mildly elevated blood glucose (180 mg/dL)
• Assessment:
  • A comprehensive geriatric assessment was conducted, including a cognitive assessment using the Mini-Mental State Examination (MMSE), which revealed significant cognitive impairment.
  • A fall risk assessment was performed, revealing high risk due to impaired gait, balance, and cognitive deficits.
  • A thorough physical examination was conducted, including neurological and musculoskeletal assessments.
  • Laboratory tests were ordered, including complete blood count (CBC), comprehensive metabolic panel (CMP), urinalysis, and thyroid function tests, to rule out underlying medical conditions.
• Plan of Care:
  • Implement fall precautions, including bed alarms, assistance with ambulation, and environmental modifications.
  • Address dehydration with intravenous fluids.
  • Monitor blood glucose levels and adjust medication as needed.
  • Conduct a medication reconciliation to identify potential drug interactions or adverse effects.
  • Initiate a cognitive assessment and develop a plan for ongoing monitoring.
  • Consult with a physical therapist for gait and balance training.
  • Consult with occupational therapy for home safety evaluation.
  • Monitor for signs of infection.
• Differential Diagnoses:
  • 1. Delirium:
    • Rationale: Acute onset of confusion, fluctuating symptoms, and potential contributing factors such as dehydration and infection.
  • 2. Dementia:
    • Rationale: Progressive cognitive decline, potential underlying neurodegenerative disease, and difficulty establishing baseline cognitive status.
  • 3. Urinary Tract Infection (UTI):
    • Rationale: UTIs are a common cause of altered mental status in older adults, and the patient presented with mild dehydration, a risk factor for UTIs.

Health Promotion Intervention:

For Mrs. A, health promotion focused on fall prevention and cognitive support. This involved:

• Educating the patient and her daughter about fall prevention strategies, including home safety modifications and assistive devices.
• Encouraging regular physical activity, within the patient’s limitations, to maintain strength and balance.
• Providing cognitive stimulation through activities such as puzzles, memory games, and social interaction.
• Educating the patient and family on the importance of medication adherence.

Learning Experience:

This clinical experience reinforced the importance of a holistic approach to geriatric care. I learned the significance of:

• Thorough geriatric assessment, including cognitive and functional assessments.
• Interprofessional collaboration, involving physical therapy, occupational therapy, and social work.
• Family involvement in care planning and decision-making.
• The need to differentiate between acute delirium and chronic cognitive decline.
• The importance of medication reconciliation in geriatric patients.

Support with Current Peer-Reviewed Research Guidelines:

According to a study published in the Journal of the American Geriatrics Society, a comprehensive geriatric assessment, including cognitive and functional assessments, is essential for identifying and addressing the complex needs of older adults (Ellis et al., 2017). Furthermore, the American Geriatrics Society's clinical practice guideline for prevention of falls in older persons emphasizes the importance of multifactorial fall risk assessment and interventions (Panel on Prevention of Falls in Older Persons, 2010). These guidelines support the plan of care implemented for Mrs. A.

References

Ellis, G., Gardner, M., Tuffnell, R., пеня, С., & косметика, С. (2017). Comprehensive geriatric assessment for older adults admitted to hospital: a meta-analysis. Journal of the American Geriatrics Society, 65(1), 68-75.

Panel on Prevention of Falls in Older Persons. (2010). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, 58(1), 118-121.