19.3 Applying the Nursing Process
Applying the Nursing Process: Assessment
When performing a comprehensive assessment on an older adult, the findings are used to establish their baseline status of physical, cognitive, psychosocial, and spiritual well-being. It is appropriate to consider the potential impact of declining strength and physical functioning on their psychological status using Erikson’s developmental stage of “Integrity versus Despair.” It is also important to consider the impact of chronic disease on their ability to function and complete Activities of Daily Living (ADLs). Many older adults who are able to perform ADLs without assistance consider themselves healthy.
When performing an assessment on an older adult, modification of communication techniques may be required, as discussed in the “Sensory Impairments” and “Cognitive Impairments” chapters. It is important to allow adequate time for older individuals to reply to questions thoughtfully and to move through the requests contained in a physical assessment comfortably.
It is helpful to use an evidence-based tool to assess for frequent needs of older adults, such as the Fulmer SPICES tool. The SPICES tool focuses on areas of common problems for aging individuals and can lead to early intervention and treatment. The SPICES tool includes assessment of the following:
S: Sleep Disorders
P: Problems with Eating or Feeding
I: Incontinence
C: Confusion
E: Evidence of Falls
S: Skin Breakdown[1]
Several free assessment tools for common issues in older adults are located at The Hartford Institute of Geriatric Nursing website. Use the box below to explore available tools.
Unexpected Findings
While cognitive impairment and memory deficits are not considered normal aspects of aging, there are common expected physiological changes that occur with aging. Nurses should be familiar with these expected findings so that deviations from the expected can be adequately addressed. See Table 19.3 for a comparison of expected versus unexpected findings in an older adult that require notification of the health care provider.[3]
Table 19.3 Expected Versus Unexpected Findings[4]
| Assessment | Expected Findings | New Unexpected Findings to Report to the Health Care Provider |
|---|---|---|
| Cardiovascular system |
|
*CRITICAL CONDITIONS requiring immediate notification or contact of emergency services: Chest pain; symptomatic hypotension or hypertension; new onset or changes in oxygenation |
| Respiratory system |
|
*CRITICAL CONDITIONS requiring immediate notification or contact of emergency services: Hemoptysis; decreased oxygen saturation levels not responding to treatments; labored breathing |
| Musculoskeletal system |
|
*CRITICAL CONDITIONS requiring immediate notification or contact of emergency services: Sudden onset of unilateral weakness, facial drooping, or slurred speech; falls with suspected injury |
| Genitourinary system |
|
*CRITICAL CONDITIONS requiring immediate notification or contact of