Healthcare Assessment: Short Answer Questions Analysis and Discussion

This healthcare assignment addresses several key aspects of geriatric care, including the assessment of altered cognition in elderly patients. The assignment begins by outlining five crucial nursing actions to take when suspecting altered cognition, supported by relevant literature. It then analyzes five pieces of information derived from a Mini-Mental State Examination (MMSE) to illustrate how nurses can effectively communicate with a patient. The importance of conducting holistic and comprehensive assessments on older adults is discussed, emphasizing the need to consider physical, psychological, and social factors. A table is provided, listing the purpose of various geriatric assessment tools, such as the MNA, Timed-Up and Go, and Berg Balance Scale. Finally, the assignment explores strategies for managing constipation in an elderly patient, considering the patient's MMSE results and offering tailored communication approaches to ensure effective instruction following.

Running head: HEALTHCARE
HEALTHCARE
Name of Student
Name of University
Author note

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Response to question 1
In the advanced age, elderly people suffer from cognition deficits and presents with
altered cognition that disrupts the activities of their daily life, leading to self-care deficits. It
is critical to note there might be various reasons that can be responsible for the presentation
of acute confusion or altered cognition of the patient and etiology can range from stroke or
cerebrovascular accidents, traumatic brain injury, transient ischemic attack to various
psychological and psychiatric conditions where there are symptoms of delirium or acute
psychosis (Liperoti et al., 2017). While different other types of neurological and
psychological conditions can led to deterioration of the cognition in the subject but these are
the various specific factors that can lead to the causation of acute confusion or altered
cognition in the elderly patients (Mola et al., 2019). When an elderly subject is admitted to
the hospital or an elderly patient who is already admitted to the hospital due to some other
disease conditions, presents with the signs and symptoms of acute confusion, there are certain
vital actions that are to undertaken by the nurse and the other health care staffs which are
according to altered cognition care evidence based practice guidelines (Seijo-Martinez et al.,
2016). At first, the first action is to obtain history of the patient following which the nursing
assessment has to be done with demonstration of effective assessment taking and clinical
reasoning to reach an effective nursing diagnosis regarding the underlying causes and factors
that has led to the acute confusion. The mini mental status examination and the neurological
examinations should be taken quickly and other associated clinical symptoms have to be
assessed and managed. The live function tests, the full blood related examination should be
requested as well (Amalia et al., 2018). The second action is critical to help the patient or
rather the elderly person to relax down. Improving calmness and mental relaxation in the
patient has to be done by the nurse. The environmental factors such lighting levels, noise and
bright colors can lead to more stress and anxiety in the subject and as a part of the second

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action, the nurse should immediately control the various stimulants that trigger a delirium or
more psychological irritation in the patient leading to worsening of altered cognition. Thus,
the environmental constraints and the aggravating factors in the physical or social
environment of the person have to be regulated and creating a calm environment is vital to
relax the patient. The right action is to ensure if the elderly person is wearing his spectacles
properly or has the hearing device working. In case the patient does not have the sensory aids,
there can be disorientation in the patient that can lead to altered cognition (Moyer et al.,
2017). The fourth action is critical and is based on a very critical clinical decision taking. If
the patient has certain severe behavioral disturbances caused by the acute confusion or altered
cognition, then antipsychotic medications should be administered to the patient although the
non -pharmacological interventions are more effective. The fifth action is to hydrate the
patient and provide proper nutrition to the patient, using reminiscence strategies such as
family photos and clock to reorient the patient. The sleep pattern of the patient has to be
bettered as well (Cheng et al., 2018).
Response to question 2
Communication between the nurse and the patient that is Mr Stan Gooding in this
case is critical and the therapeutic communication is important to normalize the cognition of
the patient. The mini mental status examination of the patient was taken and although he
scored about 10 out of 30 which mean a severe cognitive impairment in the subject but there
are five pieces of information that would help the nurse communicate with the old person.
Firstly, as for orientation, the subject was found to be oriented to country, town and the
season and this is an important piece of information that can be used by the nurse to
communicate with the patient. Secondly, as for ‘registration’ of the subject was intact and the
subject was being able to name the three objects (unrelated to each other) properly that was
been spoken to him by the examiner and the nurses who are attending Mr Stan Gooding can

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use the same information to better plan and execute their communication strategies with the
patient. Thirdly, he scored one of out of three in the recall parameter of the mini mental status
examination and it is to be noted that although the subject has deteriorated memory but not a
complete loss of it – the same piece of information from the mini mental status examination
is very much vital. The nurses should be taking this information into vital consideration while
treating, caring and assisting the patient. Fourthly, in the language and praxis parameter, in
the ‘naming’ parameter – the subject could name both the objects shown to him such as
pencil and a wristwatch and this piece of information from the mini mental status
examination is very critical to the nurses. Fifthly in the language and praxis parameter only –
the subject was able to follow the first part of the 3 stage command being given to him by the
examiner and this is very vital that this information is used by the nurses. As he is oriented to
the town and country plus season, the nurse can further reorient the subject to the same
parameters using the right reminiscence strategies. As registration is intact in patient, the
patient would be able to follow the nurse’s therapeutic instructions. As the patient had recall
somewhat present, the nurse can use this information to help him with the memory tracking
and activities of daily life. Using the language and praxis strengths of the patient, the patient
can be taught the motor learning and control strategies.
Response to question 3
It is very important for the nurse to conduct a holistic and a comprehensive
assessment for the elderly or older people while working with them to support their health
because there are always a high probability of multiple issues or rather various comorbidities
being present in the elderly person that affects not only his physical health but also affects his
biological that is physical, psychological that is mental and the social aspects of his health
and well-being to a mild to severe extent. Moreover, it is to be imperatively considered that in
an elderly person – the chances of clinical complications that can arise is quite high and this

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can progress rapidly to deteriorate the prognosis of the subject than the subjects of other age
groups, at a comparatively higher rate (Brühl et al., 2017). This is why, a comprehensive
assessment and a holistic assessment comprising of all the information relating to person’s
medical, surgical, social, demographic, economic, present illness history followed by the
comprehensive physical, mental and social assessments has to be undertaken by the nurses in
a thorough basis (Song et al., 2018). In the case of altered cognition in the patient, there can
be various underlying causes that to find out the exact cause in the nursing diagnosis is very
critical as because altered cognition can be chiefly presented in delirium, dementia and
depression. In these three cardinal condition, various aspects of the memory, alertness,
attention and other cognitive parameters are affected variedly and the management of these
three conditions which has so many overlapping regions has to be particular and specific and
that is a holistic assessment is important (Hasemann et al., 2018). Moreover it is highly
important to note that the altered cognition in the elderly lead to self-care deficits that can
affect the activities of daily life markedly thus decreasing the quality of life and health and
more complications – hence a comprehensively performed holistic assessment is important
(Kaliyaperumal et al., 2017).
Response to question 4
Tool Purpose
1.MNA (long form) Assesses the risk of malnutrition in the older
patients.
2.Timed-up and Go Assess person’s mobility with respect to
dynamic and static balance.
3. Geriatric depression scale Screens for depression in older people with

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cognitive impairment
4. Berg Balance scale Assesses falls risk of older people in the
community
5. Brief Pain Inventory Assesses the pain severity and its functional
status impact.
6. GULP Screens levels of risks associated with
dehydration.
7. Geriatric Anxiety Inventory Screens for anxiety in older people
8.KICA screening tool Assesses the cognition in elderly indigenous
Australians.
Response to question 5a
The instructions are intake of balanced and properly advised nutritious diet with
adequate fibers. The right amount of regular fluid intake has to be advised. The instructions
about the right amount of enema are important. The right use of laxatives is also instructed.
Response to question 5b
Although according to the mini mental status examination the subject, she has no
cognitive impairment as her score is 26 out of 30 - it is to be considered that her memory has
very poor as she scored just 1 out of 3 plus she has some problem or rather mild problems
calculating backwards from 100 by sevens. Her attention and calculation skills were affected
as well, mildly as well. The problem with memory can result in her forgetting about the
instructions being given to her, completely or mostly that can lead to other problems and

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complications in the patient. Thus, communicating slowly and clearly about the instruction
and helping her repeat the lines, would help her register the instructions properly this is a
very important communication and interaction strategy with the subject in this case study.
Moreover, as she has language and praxis skills intact, the intact reading and writing skills of
the subject can be taken into consideration to improve her memory skills with the instructions
following. As for a strategy, the instructions for constipation management can written down
on a piece of paper and she can read it loud, to register them and then she can also be helped
with a dairy where she can write down the instructions on her own and carry the diary on her
dress pocket. At home, the diary can be kept at observable distance and safe height.

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References
Amalia, K., Ely, R. N., Nurila, K., & Siti, K. (2018). The Multivariants of Physical Activitiy
for Cognitive Impairment Among Elderly: A Systematic Review.
Brühl, A., Hoffmann, J., Sottong, U., Isfort, M., & Tucman, D. (2017). Use of the Barthel
Index, mini mental status examination and discharge status to evaluate a special
dementia care unit. JGG, 65, 144-149.
Cheng, C. P. W., Wong, C. S. M., Lee, K. K., Chan, A. P. K., Yeung, J. W. F., & Chan, W.
C. (2018). Effects of repetitive transcranial magnetic stimulation on improvement of
cognition in elderly patients with cognitive impairment: a systematic review and
meta‐analysis. International journal of geriatric psychiatry, 33(1), e1-e13.
Hasemann, W., Tolson, D., Godwin, J., Spirig, R., Frei, I. A., & Kressig, R. W. (2018).
Nurses' recognition of hospitalized older patients with delirium and cognitive
impairment using the delirium observation screening scale: a prospective comparison
study. Journal of gerontological nursing, 44(12), 35-43.
Kaliyaperumal, D., Elango, Y., Alagesan, M., & Santhanakrishanan, I. (2017). Effects of
sleep deprivation on the cognitive performance of nurses working in shift. Journal of
clinical and diagnostic research: JCDR, 11(8), CC01.
Liperoti, R., Sganga, F., Landi, F., Topinkova, E., Denkinger, M. D., Van Der Roest, H.
G., ... & Onder, G. (2017). Antipsychotic Drug Interactions and Mortality Among
Nursing Home Residents With Cognitive Impairment. The Journal of Clinical
Psychiatry, 78(1), e76-e82.

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Mola, S. J., Calvo-Lobo, C., Gil, J. I., & Calvo, J. S. (2019). Cognitive Impairment Level and
Elderly Hip Fracture: Implications in Rehabilitation Nursing. Rehabilitation Nursing
Journal.
Moyer, H. S., Gale, J., Severe, S., Braden, H. J., & Hasson, S. (2017). Outcome measures
correlated with falls in nursing home residents—A pilot study. Physiotherapy theory
and practice, 33(9), 725-732.
Seijo-Martinez, M., Cancela, J. M., Ayán, C., Varela, S., & Vila, H. (2016). Influence of
cognitive impairment on fall risk among elderly nursing home residents. International
psychogeriatrics, 28(12), 1975-1987.
Song, X., Roy, B., Kang, D. W., Aysola, R. S., Macey, P. M., Woo, M. A., ... & Kumar, R.
(2018). Altered resting‐state hippocampal and caudate functional networks in patients
with obstructive sleep apnea. Brain and behavior, 8(6), e00994.