Nursing Assessment: Applying Hartford Tools to an Elderly Case

This assignment is a discussion post focusing on the geriatric assessment of an 82-year-old widow named Mary, living in Adelaide, who has several health complications, including hypertension, borderline dementia, and osteoarthritis. The author, a community nurse, details the experience of conduc...Read More

Running head: NURSING ASSIGNMENT
\
Nursing assignment
Name of the student
University name
Author’s note

1NURSING ASSIGNMENT
Table of Contents
Post:..............................................................................................................................................2
Background......................................................................................................................................2
Experience in completing the assessments......................................................................................2
Three findings from the assessment................................................................................................3
Outcomes developed for the client..................................................................................................4
Discussion of the post..................................................................................................................4
References....................................................................................................................................5

2NURSING ASSIGNMENT
Post:
Background
The current assignment takes into consideration a number of assessments for analysing
the condition of the patient. Here, the patient Mary was an 82 years old widow living in
Adelaide. She had been living alone after the death of her husband and has two children who stay
in Brisbane and Queensland and occasionally visiting her. Mary had been diagnosed with breast
cancer 10 years ago and had survived it. However, she had developed a number of health
complications very recently. For example, she suffers from hypertension, borderline dementia
and has osteoarthritis, which makes daily activities or movement difficult for her. She has also
had reportedly showing signs of macular degeneration which makes performing activities like
driving difficult for the patient. Mary stated that she has had an active life and had been visiting
her friends in the local community centre where she would drive herself on every Saturdays.
However, her present health condition has limited her within the four walls of her home.
Therefore, as a community nurse I was assigned with the job role of assessment of the present
health condition of the patient.
Experience in completing the assessments
I had faced a number of difficulties in conducting the health assessments of the older lady
over here. This is because the old lady had dementia, which made remembering things or
effectively reporting them difficult for her. However, on slight nagging she reported that she had
been taking three different medicines for her diabetes, hypertension and osteoarthritis. She also

3NURSING ASSIGNMENT
admitted that she had difficulty in remembering the medicine time and doses and ended up
missing medication doses quite often.
Therefore, in order to come out with an effective diagnosis a number of assessments test
were conducted for the lady such as the Katz index independence in activities of daily living,
Lawton’s instrumental activities of daily living, assessment of nutrition in the elderly,
immunizations for older adults.
Three findings from the assessment
The kat’s index independence consists of a number of activities of daily living such as -
bathing, dressing, toileting, transferring, continence and feeding. The patients are rated on a scale
of 0-1 where the patient is given 0 in case he/ she cannot perform the activities without
supervision or assistance and 1 in case they can do it alone. Here, the patient received a score of
bathing-1, dressing- 1, toileting-1, transferring-0, continence- 1, feeding- 1. Hence, the patient
could only move with the help of walking aide.
The Lawton’s instrumental activities of daily living consist of a range of activities which
are complex in nature. As mentioned by Kane, Ouslander, Abrass & Resnick (2017), one losses
the capability to perform some of these complex activities such as shopping, cooking, managing
and finances much before they lose control over their activities of daily living. These may
decline incipient decline in older adults. Here, the patents are rated on a scale of 0-8; where o
signifies low functioning whereas 8 signify high functioning (Korc-Grodzicki et al., 2015). The
patient received an average score of 4.5, which signifies risk in losing functions.
The patient reported that she had once received varicella vaccination for the treatment of
hepatitis infection and has liver issues. The patient reported that she is not very accurate about

4NURSING ASSIGNMENT
her diet and most of times would only eat two times in a day from her stocked up biscuit cans
and jars.
Outcomes developed for the client
Therefore, based upon the above assessment it can be said that the patient had movement
difficulties owing to her condition of osteoarthritis and had difficulty in cooking and shopping
for her. She also reported that she often neglected effective medications due to dementia.
Therefore, as a community nurse I will have to help the patient in regaining autonomy over most
of her activities of daily living. For example, I can use telephone to give her reminders on a six
hourly basis to take her medications; I can drive her to the shopping centres as well as help her to
the clinic to treat the condition of osteoarthritis.
Discussion of the post
Dear friend,
I have read your post on the health condition of your 87 year old African American
patient. In think you have rightfully conducted the assessments with her as taking the
immunization history is very important before starting a clinical process.
I think as you have well summed up the total scores of the patient from the Lawton
instrumental activities of living and katz index of independence. However, giving a detailed
outlook on the individual parameters considered would have been helpful. I think suggesting the
patient control exercises would have been effective enough. However, I think you should have
also mentioned provision of counselling services to the patient as the patient is an 87 year old
lady living alone as the counselling services help in supporting old age crisis to a greater extent
(Honda, Ito, Ishikawa, Takebayashi & Tierney, 2016).

5NURSING ASSIGNMENT
References
Honda, M., Ito, M., Ishikawa, S., Takebayashi, Y., & Tierney, L. (2016). Reduction of
behavioral psychological symptoms of dementia by multimodal comprehensive care for
vulnerable geriatric patients in an acute care hospital: A case series. Case reports in
medicine, 2016, 125-136.
Kane, R. L., Ouslander, J. G., Abrass, I. B., & Resnick, B. (2017). Essentials of clinical
geriatrics. London: McGraw-Hill Medical Publishing Division, 55-72.
Korc-Grodzicki, B., Sun, S. W., Zhou, Q., Iasonos, A., Lu, B., Root, J. C., ... & Tew, W. P.
(2015). Geriatric assessment as a predictor of delirium and other outcomes in elderly
cancer patients. Annals of surgery, 261(6), 1085.