As a clinician I perform a nursing assessment every day I work. A nursing assessment is a comprehensive evaluation of each realm of life. This type of evaluation is essentially the same for skilled nursing visits, benefit determinations, or a home safety/private duty assessment. Each time I meet a patient or client in their home I pay attention to the smallest of details…
Starting with home safety (about which I have recently blogged.) Is the environment clean? Is the home maintained and can the patient get in/out of their home safely? Heating and cooling adequate? Emergency exits and Plan I case of fire? Emergency numbers/contacts posted by the phone-can your Elder USE the phone? Smoke and Carbon Monoxide detectors (change the batteries on their birthday)? What is the bathroom like? Non-skid mats on the floor, approved shower chair, grab bars? Is there an emergency personal response system? I usually have the patient show me how they walk to/from the bathroom and can then get an accurate evaluation of their actual status/ability. Some folks are known to say, “Everything is just fine.”
After the ice is broken with non –clinical discussion, questioning ensues regarding functional status; including activities of daily living (ADLs.) Can they dress themselves including fastening and buttons? What about transferring in/out chair & bed? (Do they bother with a bed because it is too low or too high and instead sleep in a recliner chair?) Do they require hands on assistance from anyone or from an adaptive device like walker/ wheelchair/raised toilet seat/ and or grab bars? How is bathing achieved? Is the shower or bathtub used safely or does the individual use a basin for bathing? Is hygiene practice frequent enough for proper health? Is the patient able to control bladder and bowel function? (Check out the bathroom for underclothing that has been rinsed out and drying in the shower/tub.) Can they cook/obtain proper nutrition? Can they eat independently? A TUG test is performed (Timed Up and GO) previously described as the time in seconds it takes to rise from the chair, walk 10 feet and return to the chair and sit. The TUG is a mobility test to assess whether an individual is functioning well and safely. Scores of 25 sec or more have been to proven to be accurate indicators of whether an individual will experience falls and the often grave consequences following them.
Do they drive (should they drive?) Who manages the money? Is there social participation that prevents isolation often present in the older population? A social assessment should include what support systems may be in place. Is there a medical doctor or advance practitioner actively managing health care?
A physical assessment includes a complete set of vital signs including heart rate, blood pressure, temperature, and respiration rate. Does the patient have dizziness/weakness/fatigue/tremors/ fainting/lethargy/unsteady gait/impaired gait/impaired vision/impaired coordination/shortness of breath/ urinary frequency or urgency/incontinence of bladder or bowel/loss of appetite/loss of range of motion or cognitive defects? What is the current medication list-including over-the-counter medications? I inquire how the meds are taken and stored. Are there any expired meds in the house? Does the patient understand for what and how each med is prescribed? Is there a pill box for organizing and a check and balance system for taking the medication? What disease processes are actively affecting the patient? Does a history of other diagnosis (co-morbidities) also influence current status, i.e. cancer, fractures, dementia, diabetes mellitus, hypertension, heart disease etc. A nursing assessment steps away from the medical model because it is holistic in nature. As we care for our Elders in their homes or current living arrangement, we MUST consider all aspects of their lives: health, social, functional, and financial. Disease process does not exist in a vacuum.