Running head: Aging Paper 1

Aging Paper
Jenna M. Spotts
178564
Cedar Crest College

Aging Paper 2

Aging Paper
178564
Cedar Crest College

Aging Paper 3
Abstract
The purpose behind writing this paper was to assess a geriatric client and provide
teaching points, impact of aging, and care to M.R. who is a 65 year old female. The two main
problem areas are her pain and COPD. The client uses a lot of spirituality to help cope with these
issues and very little medication. The client is very active in her church and the extra activities
that go along with her church. The client doesnt want to grow old however comprehends that it
is a part of life and is accepting because of her spirituality. Throughout this paper are assessments
on the status of the client as well as nursing diagnoses, interventions, and goals for the client.

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Aging Paper
M.R. is a 65 year old female born on September 25, 1949. Client allowed the student
nurse to assess vital signs, her pulse was 88, respirations were 16, oral temperature was 97.6oF,
blood pressure was 135/70, and pain was reported at a 6 out of a scale of 10. Client has a past
medical history of COPD, 3 back injuries, two herniated discs, lumbar facet syndrome, a partial
hysterectomy, breast reduction, and an appendectomy. Client is married and lives in a 3 story
town house with her husband. Patient is a secretary in the process of training her replacement
because she is retiring in the next few months. Client stated that the only medications she takes is
her Spiriva and Dulera. The client is a smoker wishing to quit but needs resources and more
information to help her quit. She was diagnosed with COPD approximately five years ago and
has a family history of COPD with her mother, father and her elder sister all having and passing
from COPD.
ADLs/IADLs
The model to assess the clients ADLs was the Katz Index of Independence in Activities
of Daily Living Scale (Appendix A), this is done to assess how independent the client is when
performing everyday activities. This model assess the clients ability to bath, dress, toilet, transfer,
feed, and if the patient is continent or not (Katz, Down, Cash, & Grotz, 1970). The client scored
high on the independence model, M.R. is independent with her activities.
The model used to assess the clients IADLs was The Lawton Instrumental Activities of
Daily Living Scale (Appendix B). This test is done to measure the functional status of the client
in the home and out of the home (Lawton & Brody, 1969). The client is highly functional with
the ability to use the telephone, taking care of the shopping, preparing and shopping for meals,

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performing light daily tasks, completing the laundry, driving her own car, taking her own
medications, and managing her and her husband's financial records
COMMUNICATION
The model used to assess the clients hearing ability was the Hearing Screening in Older
Adults (Appendix C) (Ventry & Weinstein, 1983). This tool is important because the hearing in
the elderly declines as a natural aging process. It is important to assess hearing loss because it
can lead to many other problems for the older adult (Demers, 2013). The client declined any
hearing impairments in her daily life, according to the tool used this shows the client doesnt
have any hearing impairments.
The model used to assess the clients visual status was the Snellen Chart (Appendix D).
Loss of vision is common in the older adult so it is important to assess the older adults vision,
loss of vision can lead to many problems such as an increased risk for falls (Snellen Test, n.d.).
The patient scored a 20/40 which shows some decreased vision, client was still advised to visit
the eye doctor as per her routine.
ECONOMIC STATUS
When asked, the client denied having any plans for long term care. The client denied
having a living will, stated I know I should have one, we both should, but we dont (M.R.,
Personal Communication, 2014). The client denied having a POA.
LIVING/HOME ENVIRONMENT
To assess the clients home, the Fall Prevention Home Assessment Chart (Appendix E)
was used. It is important to assess the home environment for risk for falls because falls
contribute to many major health problems in the older adult, even death. Falling is an expensive

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and painful process that can greatly decrease the older adults quality of life (Fall Prevention
Task Force, n.d.).
M.R. has a well-lit path from the garage to the house. There arent any cracks in the
sidewalk or driveway. There arent any obstacles in the way of getting to the doors. There is a
well-lit path from the bedroom to the bathroom with only a grab bar in the shower. Bathmats are
slip resistant, and there wasnt any soap scum in the shower. Shower necessities are within reach.
There is a bedside lamp and table, there arent any visible cords, and the floor is clear of clutter.
There arent any throw rugs in the kitchen, all necessary items are within reach. The house is
wall to wall carpet, will only a small amount of clutter on the floor being dog toys. There is free
space to move about in the living room. There arent any visible cords or wires, and the room is
well lit.
MENTAL HEALTH
As people age, there is an increased risk for developing Alzheimers or other forms of
dementia. It is important to assess if an older adult is showing any cognitive decline (Doerflinger,
2013). The tool used to assess the clients cognitive status is The Mini-Cog (Appendix F). The
client was able to repeat the three words after the clock drawing test was performed. The client
was able to draw the clock with normal results. The client scored a 5 which is negative for
dementia (Borson, Scanlon, Brush, Vitallano, & Dokmak, 2000).
There are normal and abnormal changes in aging in the older adult. Depression is not a
normal aging change, however it is common in the older adult. Depression can go untreated
which can lead to more medical problems, it can also be treated which can help to increase the
quality of life for the older adult (Greenberg, 2012). The tool used to assess depression in the
client was The Geriatric Depression Scale (GDS) (Appendix G) (Yesavage, J.A. et al. 1983). The

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only problem area for M.R. was that she doesnt feel full of energy anymore. M.R. scored a 1 out
of 10 on the depression scale which shows that M.R. is not at risk for depression.
PHYSICAL HEALTH/NUTRITION
It is important to assess the normal and abnormal changes because a slight impairment
can put the older adult at risk for other medical problems (Fulmer & Wallace, 2012). To perform
an overall assessment on the client the model Fulmer SPICES: An Overall Assessment Tool for
Older Adults (Appendix H) was used (Fulmer, 1991). The client declined any sleep disorders,
problems with eating or feeding, incontinence, confusion, evidence of falls, or any skin
breakdown.
Pain can be acute or chronic, either way it is a common problem with the elderly. It is
important to help assess pain in the older adult because it can show underlying factors for other
problems that may not be known to the medical staff. (Flaherty, 2012). The tool used to assess
pain for the client was the Pain Assessment for Older Adults (Appendix I) (Jacox, Carr, Payne, et
al. March 1994). The client rated her pain as a 6 on a scale out of 10. The client stated that when
she wakes up the pain is around a 2 through lunch and then as she leaves work and heads home is
when her pain becomes a 6 or more. The client states that she has back problems since 1988 and
no matter what she does, nothing seems to work.
Falls contribute to too many medical problems for the older adult, and most times fall are
preventable. Many older adults have underlying factors that can contribute to a fall such as
medications, orthostatic hypotension, injury, and visual problems (Hendrich, 2013). The tool
used to assess the clients risk for falls was the Fall Risk Assessment for the Older Adults: The
Heindrich II Fall Risk Model (Appendix J) (Gray-Miceli, Johnson, & Strumpf, 2005). M.R. has a
fall score of one which does not put the client at risk for falls.

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Sleep is essential for good health, but not having enough sleep can contribute to accidents
and puts older adults at an increased risk for falls. Falls can greatly decrease the quality of life
and possibly cause death for the older adult (Smyth, 2012). The tool used to assess the quality of
sleep was The Epworth Sleepiness Scale (ESS) (Appendix K) (Johns, 1991). The client only
stated that she has a slight chance of falling asleep while she is lying down to rest in the
afternoon. M.R. denies falling asleep throughout the day.
It is valuable information to understand how the older client it nourished because
malnourishment can lead to many medical problems such as, loss of muscle mass, weight loss,
and possible premature death (DiMaria-Ghalili, & Amella 2012). The tool used to assess the
nutritional status was Assessing Nutrition in Older Adults (Appendix L) (Rubenstein, Harker,
Salva, Guigoz, Vellas, 2001). M.R. has a normal nutritional status with a score of 12.
SPIRITUALITY
When older adults face a difficult time in their lives they need someone or something to
turn to in order to help them cope. Spirituality is a way of coping for the older adult, it is
important for medical staff to ask about spirituality because it can help to show how the older
adults live their lives (Borneman, 2011). The tool used to assess spirituality in the client was the
Assessment of Spirituality in Older Adults: FICA Spiritual History Tool (Appendix M)
(Puchalski, 1996). The client considers herself to be spiritual, believes that her spiritual beliefs
help her to cope with stress. The client states her spiritual belief is extremely important to her,
she goes to church three times a week. The client states that her beliefs influenced how she takes
care of herself,helps with her back pain and COPD. When asked what role does your beliefs play
in regaining your health, the client stated I thank the Lord that its not worse, that I can go for
comfort when I am in pain, I thank him, I already prayed once, I dont want to ask him more than

Aging Paper 9
once (M.R., personal communication, 2014). The client states I am a part of a spiritual
community that is supportive to me by showing love, faith, hope, comradery, friendship, and this
is where I met my husband (M.R., personal communication, 2014). The client states that she has
a few groups of people she really loves which are her family, her church family, and her friends.
SOCIAL SUPPORT
As people age it is important to have support when hard times come by, so many go
without any type of support and they are left to deal with their problems on their own which can
decrease the quality of life and increase the risk for depression for the older adult (Sherbourne &
Stewart, 1991). The tool used to assess social support in the client was the MOS Social Support
Survey (Appendix N). M.R. was able to identify a few people in her life that she was always able
to talk to which is her husband, family, and church family.
IMPACT OF AGING
The client states that she understands that aging is a part of life, she isnt a fan of getting
older but she understands it happens. She focused a lot on the gaining weight aspect of growing
older. She has a lot of pain but wont allow it to affect her life. The client states that she doesnt
want to pass away any time soon but stated that she understands God has a plan for her and he is
the only one who knows when it is her time, and she has come to terms with this (M.R. personal
communication, 2014). The client understands that aging is a normal process of life.
COPING MECHANISMS
Throughout the assessment the client showed many positive coping mechanisms and very
few negative coping mechanisms. The client was not happy with her weight with becoming older
but for her to cope with her weight gain she used humor in a positive manner. The client is very
spiritual and this aspect of her life really helps her cope with any life obstacle that she faces. The

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client uses emotional-based coping, which is where the client is coping through emotions rather
than changing the problems through doing something (Reuman, Mitamura, & Tugade, p 92,
2013). The client did not appear sad throughout the assessment, she had her moments of being
serious but did laugh a lot. The client has a positive outlook on life which helps her to cope
appropriately. The negative coping mechanism was being disengaged, which is a type of
avoidance from a problem (Reuman, Mitamura, & Tugade, p 92, 2013). The problem the client
was avoiding is her weight, the client stated that she understood she should lose weight to be
happier and healthier but avoids the problem because she is too busy (M.R. personal
communication, 2014).
PROBLEM AREAS
The two main areas of concern for M.R. is the chronic back pain that has been a problem
since the late eighties, her recent diagnosis of COPD and still smoking. The client is in need of
some teaching points about her pain and non-pharmacological interventions for the treatment of
her pain. M.R. has seen COPD throughout her life and has some of the important information
down but still needed some guidance of non-pharmacological interventions to enhance her
breathing and quality of life. Spirituality is important to M.R. and is her main way to cope
through these problem areas, however the student nurse gave M.R. some teaching points and
interventions to better enhance her quality of life so the M.R. can stay highly active with her
church and family.
CARE PLAN
Impaired gas exchange R/T alveolar-capillary membrane changes AEB 1.5 pack/day
smoker for 30 years, family history of COPD, nasal flaring, dyspnea, and dyspnea on exertion.
The client will verbalize understanding and causative factors and appropriate interventions as

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well as participate in treatment regimen within level of ability within the next month (Doenges,
Moorhouse, & Murr, 2013). Teach the client about smoking cessation and provide tools and
brochures for helping to quit smoking. New interventions are available such as medications,
telephone counseling, and nicotine replacement. Smoking is the major risk factor for COPD,
continued smoking can lead to fixed airflow limitations (Abramson, Perret, Dharmage, V.
McDonald, & C. McDonald, 2014). Teach the client about self-management programs to
decrease the incidence of going to the hospital. These are programs aimed at teaching skills
needed to carry out medical regimens specific to the disease, guide health behavior change, and
provide emotional support for patients to control their disease and live functional lives (Disler,
Inglis, & Davidson, 2013). Teach the client about pulmonary rehabilitation and modification of
patient behavior. Pulmonary rehabilitation aims to reverse the systemic consequences of COPD,
in particular the skeletal muscle dysfunction, enhances the mechanical efficiency of physical
activities (walking) and reduces the sensitivity to dyspnea and the ventilation required to
overcome a specific task (Troosters et al., 2013).
Risk for infection R/T chronic disease of the lungs, smoker, decrease in ciliary action,
steroid use. The client will verbalize understanding of causative or risk factor(s), demonstrate
techniques, lifestyle changes to promote safe environment, and identify interventions to prevent
or reduce risk of infection within the next month. Emphasize proper hand-washing techniques
(using antibacterial soap and running water) before and after all care contacts, and after contact
with likely contaminated items. Hand-washing is a first-line defense against infections.
Encourage early ambulation, deep breathing, coughing, and position changes. This is encouraged
for early mobilization of respiratory secretions and prevention of aspiration and respiratory

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infections. Maintain adequate hydration and electrolyte balance. This is to prevent imbalances
that would predispose to infection. (Doenges, Moorhouse, & Murr, 2013).
Chronic pain R/T irritation at the posterior part of the lumbar spine, two herniated discs, 3
prior back injuries in 1988, sedentary work AEB pain rated as a 6 out of 10, abnormal walking
pattern, facial grimace while walking and sitting down. The client will demonstrate and verbalize
the relief of pain or discomfort and verbalize the understanding of behavioral modifications of
lifestyle and the appropriate use of therapeutic interventions and demonstrate these interventions
within the next month (Doenges, Moorhouse, & Murr, 2013). Teaching the client about different
physical therapies such as exercise, heat and cold application, rest, massage, acupuncture,
reflexology, and therapeutic touch. These therapies are none to be particularly soothing for
musculoskeletal pain among older people (Shovana, Schofield, & Rashmi, 2013). Teaching the
client about cognitive behavior therapy. Cognitive behavior therapy aims to reduce mental
suffering and promoting active engagement with life (Eccleston, Morley, & Williams, 2013).
Teaching the client about mind and body interventions such as yoga to alleviate the chronic back
pain. This allows the client to cultivate awareness and acceptance of physical and emotional
experiences (Keefe, Porter, Somers, Shelby, & Wren, 2013).
Activity intolerance R/T imbalance between oxygen supply and demand, sedentary job,
and smoker AEB exertional dyspnea, fatigue, and pain rated as a 6 out 10. The client will use
identified techniques to enhance activity intolerance and identify any negative factors affecting
activity tolerance and eliminate or reduce their effects within the next 6 months. Note client
reports of difficulty accomplishing tasks or desired activities. Evaluate the clients current
limitations or degree of deficit in light of usual status and what the client perceives the causes,
exacerbates, and helps the problem. This helps to provide a comparative baseline, influences

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choices of interventions, and may reveal causes that the client is unaware of affecting energy,
such as sleep deprivation, smoking, poor diet, depression, or lack of support. Ascertain ability to
sit, stand, and move about as desired. Note degree of assistance necessary. Helps to differentiate
between problems related to movement and problems related to oxygen supply and demand
characterized by fatigue and weakness (Doenges, Moorhouse, & Murr, 2013). Teach the client
about the different pharmacotherapy options available. Dynamic hyperinflation, which is
associated with decreased physical activity is shown to be improved with bronchodilator therapy,
this in turn can help increase activity levels for a patient with COPD (Troosters et al. 2013).
CONCLUSION
M.R. has some problem areas to focus on, one of her main problems is her COPD and her
smoking cessation is very important for that, as well as her overall health. The student nurse did
give M.R. some supplemental information on the benefits of quitting smoking as well as a help
line phone number for when the client has her urges. Her chance of infection puts her at high risk
as well, and with her pain and sedentary job M.R. has a risk of buildup with secretions. M.R. is
active outside of work but no longer exercises due to fatigue, dyspnea, and pain. The student
nurse did supply M.R. with information about yoga as well as some ROM exercises, the student
nurse explained that M.R. can even do these motions while at work. M.R. is highly spiritual
which helps to enhance her coping abilities and is what keeps M.R. active outside of work. The
student nurse will need to re-evaluate M.R. in the next month to evaluate the effectiveness of the
interventions provided.

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