Case Study 1: Mr. Perkins, age 81, reports for an annual physical examination. He says he is doing well. His only known problem is osteoarthritis. He also requests a flu shot. He takes no medications other than Tylenol for arthritis pain. When he walks into the exam room, you notice that he is using a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months. THEN: Review the case study and based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address. Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Thi

Case Overview

The case involves an 81 year old, Mr. Perkin, who presented for an annual physical examination. He is progressing well and has osteoarthritis. During this visit, he requests for a flu shot. Mr. Perkin’s takes no other drugs apart from Tylenol for arthritis pain. As Mr. Perkin’s walks into the examination room, you notice that he is using a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months.

Osteoarthritis (OA) is a degenerative joint disease that often affects the knee joint and is characterized by progressive tear and wear and loss of articular cartilage. It is a common diagnosis in the elderly population and in severe cases, can result in permanent disability. The prevalence of OA is higher in males compared to females. Among people aged 70 years and older, OA has a prevalence that is as high as 40% and in those aged 60 years and older with symptomatic disease, the prevalence in males and females is 10% and 13% respectively (Chen et al., 2017). A critical evaluation of Mr. Perkins demonstrates that apart from the OA-associated pain, the disease is negatively impacting his mobility. Chen et al., (2017) demonstrates that among elderly patients diagnosed with OA, decreased mobility and pain increase the risk of falls and fall-related injuries, ability to independently perform and instrumental activities of daily living (IADLs) as well as activities of daily living (ADLs). Ultimately, patients will experience a poor quality of life (QOL).

It will be important to perform a comprehensive geriatric assessment (CGA) on Mr. Perkins as the findings can help in identifying individual healthcare needs and potential gaps in care. The nurse will use the findings of the CGA to develop a personalized plan of care for optimal and patient-centric outcomes. According to Ball et al. (2019), the CGA must include the following components; psychological, physical, socio-environmental, functional, and QoL. Considering her age and underlying diagnosis, she is at a high risk of other chronic illnesses such as cancers that can also result in pain. Therefore, while conducting a comprehensive physical examination, the nurse should evaluate whether Mr. Perkin’s pain is as a result of the OA diagnosis or other chronic underlying causes. Her comprehensive laboratory evaluation should assess for

• glycemic control,
• Urea Electrolytes  and Creatinine (UECs)
• Underlying anemia,
• Renal function  test
• Liver function test (metabolism)
• Iron, folate, and vitamin B12 deficiencies

Considering Mr. Perkin’s advanced age and comorbid OA, she is at a high risk of   sustaining a fall. Therefore, it is mandatory to conduct a fall risk assessment. One of the most currently recommended and reliable tool to conduct this assessment is the Hendrich II Fall risk Model after which, the nurse can recommended practical fall prevention measures to decrease her overall fall risk Scale (Ball et al., 2019). Besides, her current status predisposes her to a high risk of geriatric depression, which has a high morbidity and mortality.  A valid and reliable tool to evaluate for geriatric depression for Mr. Perkin is the Short Form Geriatric Depression Scale (Ball et al., 2019). His evaluation should be conducted from the comfort of her home, preferably in liaison with a home health agency. During the assessment, the nurse should evaluate the patient’s support system (family) and related dynamics.

He needs to be educated about the immunization recommendations for older adults which particularly the flu vaccine and pneumococcal vaccine (Coll et al., 2019). The care plan should prioritize adequate control of pain through dosage, drug and frequency modifications until there is adequate control. Mr. Perkin will also need the intervention of an occupational and physical therapist to regain physical and functional control.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby

Chen, D., Shen, J., Zhao, W., Wang, T., Han, L., Hamilton, J. L., & Im, H. J. (2017). Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone research, 5, 16044. https://doi.org/10.1038/boneres.2016.44