M.P. is a 45-year-old woman who presents to the family practice for a yearly check-up.
Subjective Data
Married
Exercises daily
Nonsmoker, never smoked
Registered nurse in hospital setting
Has two children who live at home
No complaints at this time
Objective Data
Vital signs: T 36.7 BP 108/62 HR 62 Resp 14
Height: 5 feet, 7 inches
Weight: 160 lb
Immunizations: Up-to-date
Medications: No medications, multivitamin daily
Allergy to PCN = Hives
Questions
1.) How should the nurse proceed with the physical exam? Start by inspecting and collect vital signs, head to toe assessment, medical history, any past medical history.
2.) What interventions can help make the patient more comfortable during the physical examination? Ask what can make them more comfortable, place them a comfortable position, (place pillows as needed)
3.)What pointers or tips can the experienced nurse give to a new nurse who wants to improve his or her technique? The experienced nurse can show how to be more compasionate, observe how to make decisions, always listen to the patients, and teach critical thinking and appropriate procedures.
4.)What are the components of the general survey? Appearance, body structure, mobility, behavior, and weight measurement.
5.)How should the nurse perform the abdominal assessment? Inspect, auscultate, and palpate.
Chapter 32
P.J. is an 82-year-old man who presents to the outpatient office for a 6-month check-up.
Subjective Data
Lives in assisted living apartments
Widower
One meal a day in dining room; has light meals for breakfast and lunch
Nonsmoker, never smoked
Retired police officer
Has three grown children who live nearby
Walks with cane
Complains of urinary incontinence
Objective Data
Vital signs: T 37.7 BP 108/62 HR 62 Resp 14
Height and weight = Within normal limits
Immunizations = Up to date
Medications: Digoxin (Lanoxin) 0.5 mcg per day, hydrochlorothiazide (HCTZ) 5 mg per day, aspirin 81 mg per day
Allergy to sulfa medications = Hives
Questions
1.)What special considerations should the nurse keep in mind regarding the physical exam for individuals in this patients age group? There are certain limitations possibly in mobility and range of motion. Patient may have tenderness and strength lessened than younger individuals. The nurse should condsider what is normal for this individual.
2.)What similarities does assessment of older adults have to the assessment of younger adults? Normal older adults of no medical complication should have the same exam and able to perform with some mild loss.
3.)What are the expected findings in the older adult for the following systems: skin- clean, dry, and intact hair-and nails- clean, appropriately groomed, and not dry or brittle eyes- equal round and reactive to light and vision- can see someone near or far, ears- non-tender and no swelling, the tympanic membrane is normal in appearance with a good cone of light hearing- intact and clear, mouth- smooth, symmetrical, lips intact, moist and musculoskeletal system- full range of motion, strength is intact, no clinical deformities, reflex is intact
4.)What are some abnormal findings in the older adult for the following systems: skin- lesions, dryness/scaly, loss of elasticity/wrinkes, ecchymosis, drainage eyes-redness, dry, pupils constricted, pus and vision- difficulty, ears- keloid, wax increase, infection/redness, drainage and hearing- difficulty, mouth- dry mucous membrane, plaque, odor, dental caries and musculoskeletal- decrease range of motion, slow antalgic gait, decrease strength
5.)Based on the readings and the objective and subjective findings, what is the most likely cause of this patients urinary incontinence? The most likely cause of his urinary incontinence is due to taking a water pill and given his age, (82 years old) depending on how far he is from the bathroom and how his gait is, he may not be able to control his bladder by the time he reaches the bathroom.
6.)What interventions should be implemented for this patients urinary incontinence? Adise the patient to go to the bathroom every 2-3 hours or after a meal as to impose a bathroom schedule. I also advise the the patient every time he goes to the bathroom to make sure he has a clean depend on. I also suggest the patient perform pelvic floor exercises when he is in bed to strengthen the muscle in order to have more control of his bladder.
