Professional Documents
Culture Documents
Tara Sculthorpe
Tamera Kruikiel
“I pledge”
OLDER ADULTS HEALTH PROMOTION PROJECT 2
I had the opportunity, on two separate occasions, to interview and assess a 71-year-old
female named Pat. These meetings took place in the woman’s home. In the first meeting, after
some catching up, we delved into the questions from the Transcultural Assessment tool. The
client was comfortable, eloquent, and open to answering each of my many questions. I gathered
from our conversation that Pat was social and active. For instance, she and her husband enjoy
frequent travel and spending quality time with their five grandchildren. Furthermore, Pat wears a
Fitbit and is diligent about tracking her activity, with a goal of reaching at least 12,000 steps per
day.
Pat is also a Type II diabetic and suffers from hypertension, which she has been dealing
with for years; however, she is well-controlled with medications, none of which are included on
the BEERS criteria list. While Pat passed each of the assessment tools with flying colors
(MMSE, GDS, Katz, ADL, SPICES), she did mention pain in her right knee which has gotten
progressively worse over the past couple of years. Particularly, she complains of joint stiffness
and pain upon standing, with some relief after a few minutes of walking. Upon discovering this
information, I utilized both the Falls Risk and Pain Assessment for Older Adults tools to assess
her further. Regarding the pain scale, Pat rated her knee pain as a 7 on a 10-point scale when
standing and first initiating movement, describing the pain as “moderate to severe”. She rated her
pain a 4 on a 10-point scale after several minutes of ambulating, and described it as “mild to
According to Healthy People 2020, one of their main goals is to “improve the health,
function, and quality of life of older adults” (“Older Adults, n.d.). This includes limiting the
number of elders living with functional limitations. While Pat can get around now, without
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intervention, the condition of her knee will likely deteriorate. We discussed this, and together,
I formulated a nursing diagnosis for Pat which is: Pain related to orthopedic (knee) injury
as evidenced by the patient rates her pain a 7 on a 10-point scale when first standing and
initiating movement. Pat mentioned trying various interventions in the past to relieve her knee
pain such as cold compresses, as well as an over-the-counter knee brace. We discussed additional
interventions and she agreed that an appointment with an orthopedic doctor would be in her best
interest. Therefore, Pat’s short-term outcome is as follows: Patient will call and have scheduled
an appointment with her orthopedic doctor by end of day, March 5, 2018. This outcome is a
secondary prevention strategy as at the appointment, the doctor will likely screen her for
Patient did express concern that having to undergo any kind of knee surgery would hinder
her ability to walk and spend time with family. I explained that the recovery period from any
surgery is temporary, and the outcome will be worth it. Also, I mentioned that even if a knee
replacement is necessary, walking frequently is often part of the recovery plan. With that said,
Pat’s long-term outcome is: Patient will express a significant decrease in pain, stating a rating of
3 or below on a 10-point scale upon standing and initiating movement by 3pm on April 1, 2018.
problem.
Teaching
In conversing with Pat, it’s clear she had no cognitive issues. Pat is a retired registered
nurse, having worked at both Duke and VCU, and her husband continues to own and operate a
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small business. They live in a modest home in Chesterfield, which appears clean and safe. Pat
displayed no issues regarding her hearing or vision and seemed to have much family support,
speaking with admiration about her three children, each of whom live close by. Pat was an easy
In waiting for her appointment with the orthopedic doctor, Pat and I discussed
interventions she could utilize in the meantime. We went online and I showed her the RICE tool,
which is an easy way for her to remember potential interventions – rest, ice, compression, and
elevation (“Managing”, n.d.). She agreed to begin icing her knee each evening, as she had
“stopped doing so months ago”. As explained to the client, the cold helps to reduce pain,
inflammation, and muscle spasticity. Pat also agreed to try heat in the mornings, which may
improve blood flow to the area and reduce pain. She stated, “while I’ve tried cold compresses
before, I never thought about the benefits of applying heat. What a good idea!” Furthermore, I
encouraged Pat to continue walking as weight gain could put additional stress on the knee joint,
but with that said, listen to her body and rest as needed (Lewis, Dirksen, Heitkemper, & Bucher,
2014). Pat was open to these suggestions, and seemed appreciative of my time. She agreed to call
me after her appointment and to keep me updated on her status, at which point we would meet
again.
Pat followed up with me a couple weeks later. She was able get in rather quickly to see
the orthopedic doctor; therefore, her short-term goal of scheduling an appointment was met.
After some workup, it was determined that Pat was in fact a candidate for knee replacement
surgery as her knee joint was severely worn; however, the doctor was booked a few months out.
Pat, although a bit reluctant, scheduled her surgery for the end of May. In the meantime, the
OLDER ADULTS HEALTH PROMOTION PROJECT 5
doctor gave her a shot of cortisone. Pat expressed that she has had a great deal of relief from the
injection, and stated that her pain is now minimal; around a 2 on a 10-point scale. Therefore, her
long-term goal has also been met. However, this relief is temporary as the effects of the cortisone
will eventually wear off. By then, Pat will have had her surgery and be on the road to recovery.
While still nervous about how this surgery will impact her lifestyle, Pat was reminded
about the benefits. Per Chandran et al. (2016), after having undergone total knee arthroscopy,
“there was a substantial relief of joint pain, increased mobility, correction of deformity and an
improvement in the quality of life of the patients” (p. 299). Therefore, in maintaining her long-
term goal, a plan has been initiated in which her family has been recruited to assist Pat
postoperatively; her husband will take her to and from her surgery, and her daughter will be
assisting with cleaning and meals as needed for a few weeks. Furthermore, I supplied Pat with an
Advice Following Knee Arthroscopy information sheet, which details a list of frequently asked
questions in addition to various postop exercises. This may prove helpful to her in addition to
While my patient is relatively healthy in that her disease processes are well-controlled, as the
body ages, changes are inevitable. The elderly, just like the young, don’t want to stop what
they’re doing to deal with an injury. While my client realized she needed more invasive
interventions, she was a bit reluctant as it would temporarily affect her lifestyle. Quite frankly, I
can’t blame her. Pat was a joy to teach, and because she was so down-to-earth and receptive,
there isn’t a thing I would change regarding my teaching strategies. I’m glad that I could help Pat
OLDER ADULTS HEALTH PROMOTION PROJECT 6
see the reality of the situation at hand, and I look forward to following up with her in May to see
References
Advice following knee athroscopy. (2016). Retrieved April 03, 2018, from
file:///C:/Users/Tara/Desktop/Gero/Sculthorpe%20-
%20Knee%20Arthroscopy%20teaching%20tool.pdf
Chandran, R., Shetty,S., Shetty, A., Balan, B., Mathia, L. (2016). A study of functional outcome
after primary total knee arthroplasty in elderly patients. IAIM Journal, 3(7): 297-301.
Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical nursing:
assessment and management of clinical problems. St. Louis, Missouri: Elsevier Mosby.
http://www.realfirstaid.co.uk/musculoskeletal/
objectives/topic/older-adults