NSB103 Health Assessment - Tutorial 3 Notes

Age-Related Changes and Health Assessment of Older Adults

Ms. Gina Crumble, 79, admitted to the emergency department after a fall from a motorized scooter, sustaining a large skin tear to her left calf.
History:
- Diabetes Mellitus Type 2
- Mild renal failure
- Hypertension
In the emergency department, Gina was started on intravenous (IV) fluids and IV antibiotics.
Gina spent two days in the emergency department before a bed was found on the ward.
Upon transfer to the ward, she complained of:
- Sore sacrum
- Dehydration
- Pain
- Poor urine output
- Confusion and upset
Offered oral fluids but disliked water and received no alternative due to diabetes.
Food was provided on a tray, and she had difficulty feeding herself due to an IV in one arm and limited mobility.
Wound deterioration led to surgical debridement, causing extensive wound enlargement.
A urinary catheter was inserted and left in situ on free drainage.
Three days post-surgery, Gina developed a painful pressure ulcer on her right heel (skin broken) and sacrum (red and non-blanching, skin intact).
She was eating and drinking very little, was totally immobile, and experienced episodes of delirium.

Normal physiological changes of the skin due to aging and what impact this could have on the risk of developing skin breakdown
Gina’s previous medical history and what impact this has on Gina’s vulnerability to skin breakdown
Gina’s nutritional and hydration status and what impact this has on her risk of skin breakdown
Gina’s wounds (discuss each wound- and grade them according to STAR and Pressure Injury grading scale)
Gina’s mobility and the impact this has on her skin breakdown. What other potential complications could this lead to for an older adult?

Mrs. Mary Butterfield, 89, a long-term high-care resident, fell on her way back from her shower.
This is her third fall in the past month.
History:
- Hypertension
- Glaucoma
- Rheumatoid Arthritis
- Left-sided heart failure
Medications:
- Antihypertensive medications X2
- Panadol Osteo TDS for arthritis
- Frusemide (diuretic) once daily
- Eye drops for glaucoma
Mobilizes with a walking stick.
Anxious and distressed after the fall, losing confidence in her mobility and fearing another fall.
Cognitive status: Abbreviated Mental Test Score (AMTS) of 8/10, indicating mild cognitive impairment.

Harry Walker has cardiac and respiratory age-related changes.
At risk of complications due to:
- Atrial fibrillation (AF)
- Hypertension
- Chronic obstructive pulmonary disease (COPD)
- Prostate cancer

For measuring pain in people with dementia who cannot verbalize.
Scale components:
- Vocalization (whimpering, groaning, crying)
- Facial expression (tense, frowning, grimacing, frightened)
- Change in body language (fidgeting, rocking, guarding)
- Behavioral change (confusion, refusing to eat)
- Physiological change (temperature, pulse, blood pressure changes)
- Physical changes (skin tears, pressure areas, arthritis)
Scoring:
- 0-2: No pain
- 3-7: Mild
- 8-13: Moderate
- 14+: Severe
Harry is confused, rubbing his back, and has symptoms of a chest infection. Tool to assess his pain while confused is Abbey Pain Scale because he cannot verbalize.
During assessment:
- Groaning
- Frowning
- Guarding right lower back
- Rocking back and forth
- Slightly elevated blood pressure

Use one of the previous case studies (Gina/Mary/Harry) to write an ISBAR handover.
ISBAR Framework:
- Introduction: Your name, role, location, reason for calling.
- Situation: Patient's name, age, gender, status (stable, etc.).
- Background: Relevant details like presenting problems, clinical history, and other relevant information.
- Assessment: Assessments undertaken (vital signs, primary survey, etc.), current condition, risks, and needs.
- Recommendation/Request: Clear request or recommendation with a time frame.