Running Head: ANALYSIS OF GERIATRIC CARE NEEDS PAPER
Analysis of Geriatric Care Needs Paper
Maria Kurlenda
Ferris State University
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
Abstract
The nursing care plan for Mrs. Rodriguez who is a 60-year-old female is outlined in this paper
along with a full assessment. Three nursing diagnoses were given to Mrs. Rodriguez based on
her head to toe assessment. These nursing diagnoses are: Activity Intolerance, Chronic Pain and
Risk for Injury. Mrs. Rodriguez has shortness of breath when climbing stairs, chronic pain and
stiffness in her knees upon awakening in the morning, pitting edema in her lower extremities and
impaired vision and hearing according to her family. The medical diagnoses given to Mrs.
Rodriguez are Congestive Heart Failure and Osteoarthritis.
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
Analysis of Geriatric Care Needs Paper
The purpose of this paper is to develop a plan of care for a 60–year-old female taken
from a case study in our textbook. The Case study is outlined below as well as all of the steps
included in a care plan. A care plan is what a nurse follows to care for a patient.
Case Study
“Mrs. Rodriguez is a 60-year-old Latina who lives with her daughter and family. Her
granddaughter Elena has just started nursing school and has become more aware of her
grandmother’s health. She has noticed the following conditions, which she is afraid are signs of
health problems. Mrs. Rodriguez is complaining about her knees; they are feeling stiffer,
especially in the morning. She is having difficulty reading her crossword puzzles and states that
the letters are just too small. She hasn’t noticed it, but those around her find that she understands
them better when they look at her while they are speaking. She is also complaining that she gets
out of breath easily, especially when she is climbing the steps to her second-floor room –
something she has done without difficulty for years” (Touhy, 2012).
Assessment
On physical assessment of Mrs. Rodriguez, most aspects are within normal limits. Blood
pressure was slightly elevated but patient is on medications for hypertension. The pitting edema
in her lower extremities and shortness of breath with activity were significant findings. The
chronic pain and stiffness in her knees upon awakening in the morning are also significant
findings. Mrs. Rodriguez is at a risk for injury or falls due to her impaired hearing and vision.
See Appendix A for full nurse assessment on Mrs. Rodriguez. Also, see Appendix C for fall risk
assessment on Mrs. Rodriguez.
Diagnosis
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
The diagnosis given to Mrs. Rodriguez is Congestive Heart Failure and Osteoarthritis.
The symptoms that came to these diagnoses are chronic pain in her knees, edema in her lower
extremities, and shortness of breath with activity such as climbing the stairs. The NANDA
nursing diagnoses used based on a nursing assessment are: Activity Intolerance, Chronic Pain
and Risk for Injury.
Planning
The planning process for Mrs. Rodriguez’s health care goals is well thought out based on
her nursing diagnoses. See Appendix B for full nursing care plans based on each nursing
diagnosis. In order of priority, the nursing diagnoses given to Mrs. Rodriguez are Activity
Intolerance, Chronic Pain and Risk for Injury. The plan is for Mrs. Rodriguez to experience less
pain, have less edema in her lower extremities, have no falls or injury in the next 90 days and to
be able to climb the stairs to the second level of her home without becoming short of breath
within 30 days.
Implementation
Mrs. Rodriguez will be placed on a two liter daily fluid restriction and with a doctor’s
order placed on 20 mg of Lasix daily to help with the Congestive Heart Failure. She will also
wear bilateral knee high support stockings to help with the edema in her lower extremities. To
help with the chronic pain and stiffness in her knees from the arthritis, she will be placed on a
daily regimen of NSAIDS which will help with the pain and inflammation causing the stiffness.
A low sodium, low fat and low sodium diet will begin in place of the regular diet Mrs. Rodriguez
was maintaining. This diet will help with the Congestive Heart Failure and hypertension.
In Congestive Heart Failure, diuretics and fluid restrictions can help reduce overload on
the heart. According to an academic journal article, “Diuretics ultimately reduce the stress on
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
the heart by removing excess sodium and fluid from the body.Thiazide diuretics
(hydrochlorthiazide, chlorthalidone) are usually adequate for mild volume overload and loop
diuretics (furosemide, bumetanide, ethacrynic acid) reserved for severe volume overload. Dosing
should be based on the patients size, age, renal function and degree of edema. Excessive diuresis
should be avoided; volume depletion can cause hypotension or renal insufficiency when ACE
inhibitors are added. Weighing the patient each morning is important to monitor diuresis.
Nonsteroidal anti-inflammatory drugs may decrease diuretic efficacy” (Alt, 2002).
According to Rutledge, Donaldson and Pravikoff, weight loss, fluid and sodium intake
monitoring, elevating lower extremities to reduce swelling are the best solutions to help control
Congestive Heart Failure. Mrs. Rodriguez will be given a log to track her fluid and sodium
intake on a daily basis as well as a heart healthy weight loss guide to help her with her diet and
possibly lose some weight. Obesity is a major contributor to cardiovascular disease such as
Congestive Heart Failure. “Physiologic and metabolic changes associated with obesity
contributing to cardiovascular disease include insulin resistance, diabetes, lipid abnormalities,
hypertension, left ventricular hypertrophy (LVH), obstructive sleep apnea, and sympathetic
nervous system dysfunction. Volume overload and increased filling pressures in the heart
combined with hypertension, often contribute to LVH. In turn, the LVH can lead to heart failure,
sudden cardiac death, ventricular arrhythmias, and death after an MI” (Obesity, 2012).
Evaluation
One month after the care plan began Mrs. Rodriguez had less shortness of breath with
activity. She is able to climb the stairs to the second floor of her home without feeling out of
breath. She has some edema in her lower extremities, but it is non-pitting. The stiffness and
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
pain in her knees upon awakening in throughout the day has lessened. She rates her knee pain at
a 5 out of 10, 30 days after the implementation of the care plan. Mrs. Rodriguez has also lost
nine pounds since the first assessment.
Policy
Mrs. Rodriguez has recently applied for Social Security Disability due to her inability to
work. She is unable to work due to her activity intolerance and knee pain. She is only 62 so she
does not qualify for Medicare at this time. She does have Medicaid insurance which covers some
of her medical expenses. She has to pay out of pocket for most of her health care needs. The
only policy change to help serve Mrs. Rodriguez’s health care needs would be a quicker way to
obtain Social Security Disability Insurance because along with that, then Mrs. Rodriguez would
be eligible for Medicare to help cover her health care costs. A source for Mrs. Rodriguez to turn
to once she does have Disability Insurance and Medicare, is the MI Choice Waver Program
(Choices). This program will allow Mrs. Rodriguez to have nursing help at home as needed.
This program keeps elderly people out of the nursing homes by helping them at home as needed.
To pay for Mrs. Rodriguez’s health care expenses right now, she will use her Medicaid
and pay out of pocket for the remainder until her Medicare begins. Her family and church have
offered to contribute to her health care needs as they are able.
Conclusion
In conclusion, Mrs. Rodriguez has quite a few health problems for being a 60-year-old
female. She has history of obesity and hypertension along with new diagnoses of Osteoarthritis
and Congestive Heart Failure. A nursing care plan to address the NANDA nursing diagnoses of
Activity Intolerance, Chronic Pain and Risk for Injury was created. Each nursing diagnosis was
separately evaluated to implement a plan for Mrs. Rodriguez to manage her health care
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
problems. To help control the Congestive Heart Failure, she will begin taking a diuretic and
begin to eat a heart healthy diet including a two liter daily fluid restriction. To help control the
Chronic Pain, NSAIDS will be taken on a daily basis because the pain is thought to be caused
from Osteoarthritis. The help aid in Mrs. Rodriguez’s Risk for Injury, a safe environment will be
obtained in her home. After 30 days Mrs. Rodriguez followed her care plan and did quite well.
She is able to climb the stairs without getting short of breath, her edema in her legs has been
reduced, she has not fallen or sustained any injury and she rates her pain a 5 out of 10 which is
an improvement from 8 out of 10 on initial assessment. We will see where she stands after 90
days. She also lost nine pounds during this period of time.
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
References
Alt, M. (2002). Continuing education for nurses: title: congestive heart failure. Nebraska Nurse,
35(1), 19-21.
Choices for Older or Disabled Persons Who May Need Help Caring for Themselves. Retrieved
from http://www.michigan.gov/mdch/0,4612,7-132-2943_4857_5045-16263--,00.html
NANDA NURSING DIAGNOSIS. Retrieved from www.fchs.ac.ae/fchs/uploads/Files/Semester 1
- 2011-2012/NANDA group list.pdf
Nursing Interventions for Activity Tolerance (2012). Retrieved from http://nandanursinginterventions.blogspot.com/2012/02/nursing-interventions-for-activity.html
Obesity. (2012). ISNA Bulletin, 38(2), 9-15.
Preventing Falls in Hospitals: A Toolkit For Improving Quality of Care. Retrieved September
25, 2013 from http://www.ahrq.gov/legacy/research/ltc/fallpxtoolkit/fallpxtool3h.htm
Rutledge, D., Donaldson, N., & Pravikoff, D. (2001). Patient Education in Disease and Symptom
Management: Congestive Heart Failure. Online Journal Of Clinical Innovations, 4(2), 15
Scribd. (2013). Retrieved from http://www.scribd.com/doc/77334265/Chronic-Pain-Nanda
Touhy, T., Jett, K. (2012). Ebersole & Hess’ Toward Healthy Living: Human Needs & Nursing
Response. St. Louis, MO: Elsevier Mosby
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
Appendix A
Nursing Assessment
ALLERGIES: Penicillin
DIAGNOSES: Osteoarthritis and Congestive Heart Failure
VITAL SIGNS:
BP: 132/74
P: 92
R: 16
T: 98.4 °F
HT: 5 ft. 2 in.
WT: 182 lbs
ASSESSMENT – Explain ALL answers that are not within normal limits
NUTRITION:
Diet: Regular
Recent weight change: No
Supplements: No
Conditions affecting eating, chewing, or swallowing: No
Monitoring required at mealtimes: No
Mucous membranes: Moist
Skin turgor: Good
ELIMINATION:
Bladder Incontinence: None
Bowel Incontinence: None
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
Incontinence management techniques: Yes –frequent use of restroom to prevent
accidents.
Bowel sounds present: Yes
Constipation: No
Ostomies: No
SENSORY:
Vision: Impaired
Hearing: Impaired
Corrective device: ___none___
Hearing aid: No
MUSCULOSKELETAL:
Mobility: Normal
Assistive Devices: No
ROM: Limited – due to pain in knees when bending
ADLs: (S=self; A=assist; T=total) Eating: __S__ Bathing: __S__ Dressing: __S__
SKIN:
Normal
Skin Intact: Yes
Special Care or Monitoring: No
NEURO:
Sensation: Intact
Pain: Daily – knees are stiff and painful upon awakening in the morning
Verbal Response: A/O x ___3__
Aphasia: None
Memory Deficits: No
Impaired Decision-making: No
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
Sleep Aids: No
Sleep Pattern: _Generally sleep 7-8 hours a night__
Seizures: No
CIRCULATION:
History: Hypertension
Pulse: Regular
Skin: consistent with ethnicity
Warm and Dry
Edema: Yes
Pitting: Yes – feet and ankles
RESPIRATION:
Respirations: Regular and Unlabored
Breath Sounds: Right (Clear, diminished) Left (Clear, diminished)
Shortness of Breath: Yes – with activity such as climbing stairs to 2nd floor of home
Respiratory Treatments: None
DENTAL:
Dentures
Dental Hygiene: Good
PSYCHOSOCIAL:
Self Injurious Behavior: No
Aggressive Behavior: No
Behavior: Calm
Answers Questions: Readily
Delusions and/or Hallucinations: No
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
MEDICATIONS
& TREATMENTS:
Metoprolol 12.5 mg bid
Lisinipril
20 mg daily
SAFETY NEEDS:
Is the environment safe for the resident? Yes
(Adequate lighting, open traffic areas, non-skid rugs, appropriate furniture & assistive devices)
Comments: Patient is at risk for falls due to her vision and hearing impairment.
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ANALYSIS OF GERIATRIC CARE NEEDS PAPER
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Appendix B
Nursing Care Plan #1
Activity Intolerance
Assessment
Analysis
Planning
Subjective and Objective Data
Nursing Diagnosis
Short and long term goals
Subjective: Shortness of breath
when climbing stairs to second
level of home.
Nursing diagnosis: Activity
Intolerance
NANDA definition: “Insufficient
physiological or psychological
energy to endure or complete
required or desired daily
activities” (Nursing, 2012).
Short term goal #1: Ease of
ability to climb stairs to second
level of home after 30 days.
Long term goal #1: Have no
shortness of breath with activity
within 90 days of care plan
beginning.
ANALYSIS OF GERIATRIC CARE NEEDS PAPER
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Nursing Care Plan #2
Chronic Pain
Assessment
Analysis
Planning
Subjective and Objective Data
Nursing Diagnosis
Short and long term goals
Subjective: Stiffness and pain in
knees upon awakening in the
morning.
Nursing diagnosis: Chronic pain
NANDA definition: “Pain is
whatever the experiencing
Objective: Pain rating of 8 out of person says it is, existing
10 in knees.
whenever the person says it
does, an unpleasant sensory and
emotional experience arising
from actual or potential tissue
damage or described in terms of
such damage; sudden or slow
onset of any intensity from mild
to severe, constant or recurring,
without an anticipated or
predictable end and a duration
>6 months; a state in which an
individual experiences pain that
persists for a month beyond the
usual course of an acute illness
or a reasonable duration for an
injury to heal, is associated with
a chronic pathologic process, or
recurs at intervals for months or
years” (scribd., 2013).
Short term goal #1: Pain rating
of 5 or less out of 10 after 30
days.
Long term goal #1: Ease of
stiffness in knees upon
awakening and Pain rating of 3
or less out of 10 after 90 days.
ANALYSIS OF GERIATRIC CARE NEEDS PAPER
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Nursing Care Plan #3
Risk for Injury
Assessment
Analysis
Planning
Subjective and Objective Data
Nursing Diagnosis
Short and long term goals
Subjective: Impaired vision and
hearing according Mrs.
Rodriguez’s family.
Nursing diagnosis: Risk for
Injury
NANDA definition: “At risk of
injury as a result of the
interaction of environmental
conditions interacting with the
individual’s adaptive and
defensive resources” (NANDA).
Short term goal #1: No falls or
injury after 30 days.
Long term goal #1: No falls or
injury after 90 days.
ANALYSIS OF GERIATRIC CARE NEEDS PAPER
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Appendix C
Morse Fall Scale
Item
Item
Score
Patient Score
1. History of falling (immediate or previous)
No 0
Yes 25
_____25_______
2. Secondary diagnosis (≥ 2 medical diagnoses in
chart)
No 0
Yes 15
______15________
None/bedrest/nurse assist
Crutches/cane/walker
Furniture
0
15
30
_______0_______
4. Intravenous therapy/heparin lock
No 0
Yes 20
______0________
0
10
20
_______0_______
0
15
________0______
3. Ambulatory aid
5. Gait
Normal/bedrest/wheelchair
Weak*
Impaired†
6. Mental status
Oriented to own ability
Overestimates/forgets limitations
Total Score‡: Tally the patient score and record.
<25: Low risk
25-45: Moderate risk
>45: High risk
_______40_______
* Weak gait: Short steps (may shuffle), stooped but able to lift head while walking, may seek support
from furniture while walking, but with light touch (for reassurance).
† Impaired gait: Short steps with shuffle; may have difficulty arising from chair; head down; significantly
impaired balance, requiring furniture, support person, or walking aid to walk.
‡ Suggested scoring based on Morse JM, Black C, Oberle K, et al. A prospective study to identify the fall-
ANALYSIS OF GERIATRIC CARE NEEDS PAPER
prone patient. Soc Sci Med 1989; 28(1):81-6. However, note that Morse herself said that the appropriate
cut-points to distinguish risk should be determined by each institution based on the risk profile of its
patients. For details, see Morse JM, Morse RM, Tylko SJ. Development of a scale to identify the fallprone patient. Can J Aging 1989;8;366-7.
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