caring for older adults holistically, 4th edition chapter fourteen physiological assessment pati...

Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition

Chapter FourteenChapter Fourteen

Physiological Assessment

Pati L.H. Cox, RN, BSN, M.Ed.

1-2008


Holistic AssessmentHolistic Assessment

Holistic assessments go beyond the physical assessment

Include all aspects of the older person’s life Used to improve person’s overall health and

happiness Need to obtain holistic information that consists of

general information about the person


Holistic AssessmentHolistic Assessment

Holistic information Exercise plan; eating pattern; consumption of

alcohol, caffeine, and water; sleep patterns; smoking habits; stress management techniques; sexual activity; medication record


Physical AssessmentPhysical Assessment

The physical assessment includes a history of any problems related to the system being assessed

Actual assessment consists of inspection and palpation



Assess by system Head, neck, and face

History Thyroid problems, head injury, neck injury

Inspection Head– position, shape, size, symmetry, hair pattern Face– facial muscles Neck– venous distention, range of motion



Head, neck, and face (cont.) Palpation

Trachea, cervical muscles, carotid pulses, edema, tenderness

Nose and sinuses History

Problems with nose or sinuses



Nose and sinuses Inspection

Size, shape, color of nose, swelling, drainage, difficulty moving air through nostrils, ability to smell

Palpation Tenderness, masses



Eyes History

Changes in vision, excessive tearing, discharge Inspection

Symmetry of eyebrows, pupils Redness, swelling, discharge Perform eye exam using Snellen’s eye chart Check glasses



Ears History

Hearing loss, corrective devices, pain in ears, dizziness, drainage

Inspection Do you have to repeat, size, shape, symmetry, lesions

Palpation Pain or tenderness



Mouth and throat History

Pain, swelling, difficulty swallowing, sensitive teeth, fit of dentures, last dental exam

Inspection and palpation Gums pink, moist, smooth Teeth in good repair Dentures fit well Gag reflex and uvula



Neurological History

Headaches, shaking, trembling, confusion or memory loss, seizure disorder

Inspection Level of orientation Strength and symmetry of upper and lower extremities Gait



Peripheral vascular History

History of diabetes Pain, aches, numbness, or tingling in calves, feet,

buttocks, or legs Swelling in legs at end of day



Peripheral Vascular Inspection

Color of skin in upper and lower extremities Edema in feet and legs Venous stasis ulcers, ulceration on feet

Palpation Skin temperature, pulses



Cardiac History

Shortness of breath, chest pain History of smoking, exercise

Inspection Visual pulsations, lifts, heaves Cough, shortness of breath Cyanosis of mucous or nail beds



Cardiac (cont.) Palpation

Thrills, heaves, lifts Capillary refill Skin temperature Blood pressure

Auscultation Irregular heartbeat Murmurs



Respiratory History

Difficulty breathing, cough, pneumonia, lung disease Oxygen use Vaccinations

Inspection Use of accessory muscles, nasal flaring, cyanosis Posture



Respiratory (cont.) Palpation

Masses and tenderness of ribs Auscultation

Abnormal sounds on inspiration and expirationCrackles, wheezing, whistling, pleural

friction rub



Gastrointestinal History

Nutritional status, bowel habits, medications Difficulty swallowing

Inspection Skin lesions on abdomen or in skin folds



Gastrointestinal (cont.) Auscultation

Listen to all four quadrants for bowel sounds Palpation

Ask about possible pain in abdomen Feel for masses or rigidity



Integumentary History

Skin problems, allergies, skin regimen Inspection

Observe entire body, including fingernails and toenails Check for pallor, jaundice, petechiae, cyanosis,

erythema Pressure ulcers and other lesions



Integumentary (cont.) Palpation

Turgor, texture, and temperature Musculoskeletal

History Pain in joints and back

Inspection Observe gait, range of motion



Reproductive—Female History

Prior problems with breasts Menopause Last pap smear Sexual activity



Reproductive—Female (cont.) Inspection

Observe breasts for symmetry, discharge from nipples, lumps, discoloration

Observe genitalia for discharge, lesions, rash, discoloration



Reproductive—Male History

Changes in urinary stream Urinary frequency or urgency Burning on urination Sexual activity

Inspection Lesions, rashes, discoloration, discharge, circumcision



Urinary History

Prior problems with urinary tract Medications affecting urination Surgeries Renal disease

Inspection Amount and color of urine



Urinary (cont.) Palpation

Bladder distention, masses

Functional assessment Important as physical assessment Evaluate physical, cognitive, and social function Evaluate strengths and deficits



Functional assessment (cont.) Activities of daily living

Katz’s ADL scale Direct observation most valid indicator Self-care tasks

Instrumental activities of daily living Lawton’s scale for IADLs Home-care tasks



Functional assessment (cont.) Social function

How person interacts with self, the environment, and others

Cultural and economic background

caring for older adults holistically, 4th edition chapter fourteen physiological assessment pati...

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