1. Caring for Older Adults Holistically, 4th Edition Chapter Fourteen Physiological Assessment Pati L.H. Cox, RN, BSN, M.Ed. 1-2008

2. Caring for Older Adults Holistically, 4th Edition Holistic Assessment  Holistic assessments go beyond the physical assessment  Include all aspects of the older person’s life  Used to improve person’s overall health and happiness  Need to obtain holistic information that consists of general information about the person

3. Caring for Older Adults Holistically, 4th Edition Holistic Assessment  Holistic information  Exercise plan; eating pattern; consumption of alcohol, caffeine, and water; sleep patterns; smoking habits; stress management techniques; sexual activity; medication record

4. Caring for Older Adults Holistically, 4th Edition Physical Assessment  The physical assessment includes a history of any problems related to the system being assessed  Actual assessment consists of inspection and palpation

5. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Assess by system  Head, neck, and face  History  Thyroid problems, head injury, neck injury  Inspection  Head– position, shape, size, symmetry, hair pattern  Face– facial muscles  Neck– venous distention, range of motion

6. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Head, neck, and face (cont.)  Palpation  Trachea, cervical muscles, carotid pulses, edema, tenderness  Nose and sinuses  History  Problems with nose or sinuses

7. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Nose and sinuses  Inspection  Size, shape, color of nose, swelling, drainage, difficulty moving air through nostrils, ability to smell  Palpation  Tenderness, masses

8. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Eyes  History  Changes in vision, excessive tearing, discharge  Inspection  Symmetry of eyebrows, pupils  Redness, swelling, discharge  Perform eye exam using Snellen’s eye chart  Check glasses

9. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Ears  History  Hearing loss, corrective devices, pain in ears, dizziness, drainage  Inspection  Do you have to repeat, size, shape, symmetry, lesions  Palpation  Pain or tenderness

10. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Mouth and throat  History  Pain, swelling, difficulty swallowing, sensitive teeth, fit of dentures, last dental exam  Inspection and palpation  Gums pink, moist, smooth  Teeth in good repair  Dentures fit well  Gag reflex and uvula

11. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Neurological  History  Headaches, shaking, trembling, confusion or memory loss, seizure disorder  Inspection  Level of orientation  Strength and symmetry of upper and lower extremities  Gait

12. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Peripheral vascular  History  History of diabetes  Pain, aches, numbness, or tingling in calves, feet, buttocks, or legs  Swelling in legs at end of day

13. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Peripheral Vascular  Inspection  Color of skin in upper and lower extremities  Edema in feet and legs  Venous stasis ulcers, ulceration on feet  Palpation  Skin temperature, pulses

14. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Cardiac  History  Shortness of breath, chest pain  History of smoking, exercise  Inspection  Visual pulsations, lifts, heaves  Cough, shortness of breath  Cyanosis of mucous or nail beds

15. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Cardiac (cont.)  Palpation  Thrills, heaves, lifts  Capillary refill  Skin temperature  Blood pressure  Auscultation  Irregular heartbeat  Murmurs

16. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Respiratory  History  Difficulty breathing, cough, pneumonia, lung disease  Oxygen use  Vaccinations  Inspection  Use of accessory muscles, nasal flaring, cyanosis  Posture

17. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Respiratory (cont.)  Palpation  Masses and tenderness of ribs  Auscultation  Abnormal sounds on inspiration and expiration  Crackles, wheezing, whistling, pleural friction rub

18. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Gastrointestinal  History  Nutritional status, bowel habits, medications  Difficulty swallowing  Inspection  Skin lesions on abdomen or in skin folds

19. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Gastrointestinal (cont.)  Auscultation  Listen to all four quadrants for bowel sounds  Palpation  Ask about possible pain in abdomen  Feel for masses or rigidity

20. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Integumentary  History  Skin problems, allergies, skin regimen  Inspection  Observe entire body, including fingernails and toenails  Check for pallor, jaundice, petechiae, cyanosis, erythema  Pressure ulcers and other lesions

21. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Integumentary (cont.)  Palpation  Turgor, texture, and temperature  Musculoskeletal  History  Pain in joints and back  Inspection  Observe gait, range of motion

22. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Reproductive—Female  History  Prior problems with breasts  Menopause  Last pap smear  Sexual activity

23. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Reproductive—Female (cont.)  Inspection  Observe breasts for symmetry, discharge from nipples, lumps, discoloration  Observe genitalia for discharge, lesions, rash, discoloration

24. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Reproductive—Male  History  Changes in urinary stream  Urinary frequency or urgency  Burning on urination  Sexual activity  Inspection  Lesions, rashes, discoloration, discharge, circumcision

25. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Urinary  History  Prior problems with urinary tract  Medications affecting urination  Surgeries  Renal disease  Inspection  Amount and color of urine

26. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Urinary (cont.)  Palpation  Bladder distention, masses  Functional assessment  Important as physical assessment  Evaluate physical, cognitive, and social function  Evaluate strengths and deficits

27. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Functional assessment (cont.)  Activities of daily living  Katz’s ADL scale  Direct observation most valid indicator  Self-care tasks  Instrumental activities of daily living  Lawton’s scale for IADLs  Home-care tasks

28. Caring for Older Adults Holistically, 4th Edition Physical Assessment  Functional assessment (cont.)  Social function  How person interacts with self, the environment, and others  Cultural and economic background