Nursing Medical Surgical Topic

1. GERIATRIC
ASSESSMENT

2. DEFINITION
Geriatrics-
Geriatrics is the branch of medicine dealing with the problem of
the ageing and the diseases of the elderly and management of the
diseases of older adults.
The branch of medicine dealing with the health and care of old
people

3. Geriatric Nursing-
It is the field of nursing that specializes in the care of the
elderly.
Gerontological nursing is the specialty of nursing
pertaining to older adults.

4. ASSESSMENT OF ELDERLY
The geriatric assessment is a multidimensional,
multidisciplinary diagnostic instrument designed to
collect data on the medical, psychosocial and
functional capabilities and limitations of elderly
patients.

5. COMPONENTS OF GERIATRIC
ASSESSMENT
1.History
2.The Physical Examination
3.Neuropsychiatric Examination
4.Functional Examination

6. 1- HISTORY
The geriatric assessment incorporates all
aspects of a conventional medical history
including demographic data, chief complaint,
present illness, past and current medical
problems, family and social history.

7. A) DEMOGRAPHIC DATA
It includes the following
•Full name
•Age, sex and birth date
•Marital status
•Source of history and reliability of
historian

8. B) CHIEF COMPLAINT AND
PRESENT ILLNESS
Elderly patients are famous for presenting with
any combination of non-specific, apparently
unrelated and seemingly trivial complaints.
Sometimes they have no complaint at all.
Chief complains includes -
•Primary reason for visit, ideally in patient's own
words
•Duration of presenting symptoms

9. C) PAST MEDICAL HISTORY
This includes the assessment of the following
things
Previous medical history.
General state of health
Childhood diseases
Immunizations (Tetanus-diphtheria,
pertussis, measles, mumps, rubella, hepatitis
A&B, influenza, varicella, h. flu., polio)

10. Chronological list of adult medical
diseases, injuries
Hospitalizations
Allergies
Medications, including dosage, duration
and indication
Diet

11. D) NUTRITIONAL
ASSESSMENT
Nutritional assessment involves the evaluation of :
• Current weight in comparison to ideal body
weight, with determination of BMI to evaluate for
underweight or obesity.
• Recent changes in body weight.
• Current medications and their potential to affect
the patient's nutritional status.

12. • Functional status to determine if the patient
can purchase and prepare food for Himself,
plus mental status with regard to their interest
in food.
• Food intake by food groups for a quick
estimation of adequacy of diet.
• Vitamin/mineral supplementation.

13. E) SOCIAL HISTORY
It address familial,
occupational, and
recreational aspects of
the patient's personal
life. The components
of social history are
Substances (Alcohol,
Tobacco, illicit drugs)
occupation
sexual preference
Travel &
exercise
Living arrangements,
financial security,
access to medical
services
Recreational Activity,
Sleep

14. F) SOCIAL NETWORKS
The assessment of social networks involves
collecting information on
(1) marital status,
(2) number of children and the frequency of
their visits,
(3) existence and involvement of other close
relatives or close friends, and
(4) frequency of attendance at religious and
secular meetings or events.

15. 2- PHYSICAL EXAMINATION
The physical examination includes physical assessment of patient
from head to toe and the systemic evaluation. It is a major tool for
the diagnosis of elderly problems.
It includes
1- General Appearance
Apparent age, state of health, nutritional status, alertness, and
evidence of discomfort.
2- Vital Signs
Temperature, blood pressure, pulse rate and rhythm (regular or
irregular), and
respiratory rate and pattern.
3- Skin

16. 4- Lymph nodes
Size, consistency, mobility and tenderness in occipital,
cervical, post-auricular, submandibular, supra-clavicular,
axillary and inguinal regions.
5- Head
Size, symmetry, evidence of trauma, tenderness (including
sinuses), masses, and condition of scalp.
6- Eyes
Eyebrows, lids, conjunctival inflammation and scleral icterus;
corneal opacities and abrasions; pupillary size, equality and
reaction to light and accommodation; extraocular movements
and exophthalmos; fundi for discs, vessels, macula, exudates
and hemorrhages; gross visual acuity and fields.
7- Ears

17. 8- Nose
Deformities and septal deviation; obstruction, mucous
membrane inflammation, polyps, bleeding and discharge.
9- Mouth
Lip color, lesions and pigmentations; condition of teeth;
gingival color, inflammation, and bleeding; tongue color,
moisture, tremor and coating; buccal mucosa inflammation
and eruptions; soft palate; odor of breath. If patient wears
dentures, remove them.
10- Throat
Mucosal color, exudates and lesions; tonsil size, symmetry
and exudates; post-nasal discharge.
11- Neck
Range of motion; pain and tenderness; tracheal position,
thyroid size, symmetry and consistency; carotid impulse

18. 12- Back
Range of motion; pain and tenderness over spine, muscles
and costovertebral angle; symmetry.
13- Thorax
Shape and symmetry in excursion; intercostal retractions; rib
tenderness and chest wall masses.
14- Lungs
Percussion, auscultation, bronchophony, egophony,
pectoriloquy and fremitus.
15- Breasts
Size, shape, symmetry, tenderness and masses.
16- Heart
Precordial movement, apical impulse, rate and rhythm; heart
sounds, murmurs, rubs and gallops.

19. 17- Abdomen
Shape, tenderness, bowel sounds and bruits; size of liver,
spleen, and kidneys; masses
18- Extremities
Deformities, tenderness, localized swelling, peripheral
pulses and edema, cyanosis, clubbing, temperature,
varicose veins, and hair loss.
19- Musculoskeletal
Joint mobility, tenderness, effusion, erythema and
deformity.
20- Neurologic
Screening exam in non-neurologic cases, otherwise full
exam. Mental status; cranial nerves; peripheral strength,
tone and sensation; deep tendon reflexes; Rhomberg and

20. 21- Female Pelvic and Rectal
External genitalia; speculum exam for vaginal
mucosa and cervix, bimanual exam for uterus,
masses and tenderness; digital rectal.
22- Male Pelvic and Rectal
Inguinal hernias; scrotal and testicular masses
and tenderness; digital rectal, with prostate
exam.

21. 3- NEUROPSYCHIATRIC
EXAMINATION
Neurological and psychiatric examinations
comprise a significant portion of the Geriatric
Assessment.
This is because illnesses such as dementia and
delirium are common among elderly patients.
It includes (Mini-Mental State Examination)
1. Cognitive Assessment
2. Mood Assessment
3. Substance Abuse
4. Competency

22. 4- FUNCTIONAL
ASSESSMENTFunctional impairment is defined as difficulty
performing, or requiring the assistance of another
person to perform, one or more of the following
Activities of Daily Living (ADL)
It includes the assessment of