NRS 434 Topic 5: Health Assessment of the Older Adult
Topic 5: Health Assessment of the Older Adult
School-age children include those between the ages of 5 to 12 years, also referred to as middle childhood. The school-age child’s growth presents with gradual growth and development with notable differences in weight, height, and body build (Riley, Morrison & McEvoy, 2019). Besides, language skills continue to develop, and most behavior changes occur as they strive to find their place among their peers. In this regard, this paper will describe the physical assessment of school-aged children, including the typical developmental stages of a child 12-year-old child, and apply the Piaget theory to assess a school-age child developmentally.
Physical Assessments among School-Aged Children
Physical assessment of school-age children is similar in that the examiner applies the four techniques of inspection, palpation, percussion, and auscultation when conducting a head-to-toe exam. The examiner begins the physical exam by taking vital signs, including blood pressure, heart rate, respiration, and temperature (Riley et al., 2019). However, the blood pressure cuff differs based on the child’s age and size. The height and weight are taken and plotted against a growth graph to assess the child’s nutritional status. Additionally, the general appearance of the school-age child is documented, which includes the hygiene status, dressing, signs of neglect, and mannerism (Riley et al., 2019). The examiner also assesses the child for physical signs of abuse since school-aged children are vulnerable to abuse. Assessment of the reproductive system varies among school-aged children based on age. Children above ten years are assessed for secondary sexual characteristics, including breast growth and pubic hair, which is not the case for those below ten years (Riley et al., 2019). Physical assessments of school-age children also entail dental and vision screening to assess dental cavities and visual defects.
For a child aged 5-10 years, I would use a simple drape over their underpants or a colorful examination gown and cover the parts not being assessed to maintain privacy. Fr the younger child, I would conduct the exam in the caregiver’s presence to relieve anxiety and promote cooperation (Riley et al., 2019). However, examination of the older child would be performed in the caregiver’s absence to maintain privacy. Furthermore, I would start with the least distressful exam procedures and end with the most distressful and body parts associated with pain.
Typical Developmental Stages of a 12-Year-Old Child
A 12-year-old is characterized by numerous physical, cognitive, emotional, and social changes. Physical changes include the development of secondary sexual characteristics attributed to hormonal changes. Most males grow facial and pubic hair, and the voices deepen while most females grow pubic hair and breasts and start their menstruation (Sawyer et al., 2018). At 12 years, the child enjoys all physical activities and continues to improve their motor coordination. Cognitive changes include demonstrating an increased ability for complex thought and express feelings through talking (Sawyer et al., 2018). The child also develops a stronger sense of right and wrong. Emotional and social changes include expressing more concern about body image, looks, and clothes and experiencing more moodiness. Besides, 12-year-olds tend to focus on themselves, going back and forth between high expectations and lack of confidence (Sawyer et al., 2018). They also show more interest in and influence by peer group but express less affection toward parents and at times might seem rude or short-tempered.
Applying Piaget Developmental Theory to Developmentally Assess the Child
The school-age child falls in the concrete operational stage of Piaget’s cognitive development. The stage is characterized by more logical and methodical manipulation of symbols (Babakr et al., 2019). The child is less egocentric and more aware of the outside world and events. They are also able to function on a higher level in their mental ability. I would developmentally assess a child using the Piaget theory by giving the child a fictional problem or scenario and asking them to solve it (Babakr et al., 2019). I will assess if the child can solve the problem without physically encountering it in the real world.
During the assessment, I would offer explanations using simple terms and language in line with the child’s cognitive developmental stage. I would also answer questions openly and in simple terms and ask the child questions to establish trust and promote cooperation (Riley et al., 2019). Besides, I will explain the assessment procedures to the child using simple terms before beginning the exam to promote cooperation and alleviate anxiety. I would also inform the child of the painful or distressing procedures to prepare them psychologically and increase their cooperation (Riley et al., 2019). After the assessment, I will explain to the child of the abnormal findings, possible causes for these findings, and any diagnostic procedures that will be required.
The physical assessment of the school-age child follows the head-to-toe approach and uses the basic examination techniques of inspection, palpation, percussion, and auscultation. The assessment should include taking vital signs, height and weight, general survey, dental and vision screening. Developmental stages of a 12-year-old include development of secondary sexual characteristics, increased cognitive capacity, and social and emotional changes. A school-aged child falls in the concrete operational stage in the Piaget theory and can be used to assess whether the child can function on a higher level in their mental ability.
Babakr, Z. H., Mohamedamin, P., & Kakamad, K. (2019). Piaget’s Cognitive Developmental Theory: Critical Review. Education Quarterly Reviews, 2(3), 517-524.
Riley, M., Morrison, L., & McEvoy, A. (2019). Health Maintenance in School-Aged Children: Part I. History, Physical Examination, Screening, and Immunizations. American family physician, 100(4), 213-218.
Sawyer, S. M., Azzopardi, P. S., Wickremarathne, D., & Patton, G. C. (2018). The age of adolescence. The Lancet Child & Adolescent Health, 2(3), 223-228. https://doi.org/10.1016/S2352-4642 (18)30022-1
Complete the Digital Experience. The estimated average time to complete this assignment is 1 hour and 30 minutes. Please note, this is an average time. Some students may need longer.
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Benchmark – Human Experience Across the Health-Illness Continuum
The benchmark assesses the following competency:
Benchmark: 5.1. Understand the human experience across the health-illness continuum.
Research the health-illness continuum and its relevance to patient care. In a 750-1,000 word paper, discuss the relevance of the continuum to patient care and present a perspective of your current state of health in relation to the wellness spectrum. Include the following:
- Examine the health-illness continuum and discuss why this perspective is important to consider in relation to health and the human experience when caring for patients.
- Reflect on your overall state of health. Discuss what behaviors support or detract from your health and well-being. Explain where you currently fall on the health-illness continuum.
- Discuss the options and resources available to you to help you move toward wellness on the health-illness spectrum. Describe how these would assist in moving you toward wellness (managing a chronic disease, recovering from an illness, self-actualization, etc.).
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Topic 5 DQ 1: Topic 5: Health Assessment of the Older Adult
Describe the characteristics of the aging process. Explain how some of the characteristics may lead to elder abuse (memory issues, vulnerability, etc.). Discuss the types of consideration a nurse must be mindful of while performing a health assessment on a geriatric patient as compared to a middle-aged adult.
As adults age into older adults, they go through many changes. Physical changes such as graying thinning hair, joint mobility, or muscle wasting may begin to become more prominent (Grand Canyon University, 2018). Additionally, cognitive health may also start to change. Older adults may start to see a loss in short-term memory or the ability to concentrate and organize (Grand Canyon University, 2018). Erikson’s Theory of Psychosocial Development places adults that are 65 years and older into the Ego Integrity vs. Despair phase. This is often a time in an older adult’s life filled with reflection of the past. Adults experience feelings of satisfaction looking back on their lives while some may be filled with regret that were not able to accomplish everything they hoped to in life (Grand Canyon University, 2018). Overall, the aging process of the older adult consists of cognitive, physical, emotional and many other changes.
According to the World Health Organization (WHO), “around 1 in 6 people 60 years and older experienced some form of abuse in community settings during the past year” (“Elder abuse”, 2018 para.1). Abuse can be inflicted through many different forms such as financial, physical, sexual, emotional, or neglect (“Elder Abuse and Neglect”, 2019). Older adults are physically frailer, may not hear or see as clearly as they used to, or may have mental ailments which put them at a high risk for abuse or getting taken advantage of (“Elder Abuse and Neglect”, 2019). If an adult cannot hear or see as well, this may cause frustration from their family or caregiver. A family adult caregiver may be stressed taking care of their loved one and feel isolated, depressed, or mentally overwhelmed. This also can place the older adult at risk for abuse from a close loved one (“Elder Abuse and Neglect”, 2019).
Assessment of the older adult versus middle-age adult is different because it factors in the expected changes of this population. The nurse must consider physical and cognitive changes when examining this patient. According to chapter 5 in our text (Grand Canyon University, 2018), assessing the hearing acuity of an older adult may be difficult since the individual may not even be aware of the loss that has happened over time. Additionally, the nurse needs to incorporate a cognitive assessment which typically is not necessary for the middle-aged adult. Recognizing cognitive deficits early is important since some of these conditions can be reversible or managed with medications (Grand Canyon University, 2018). If the cognitive screening would be positive, the nurse could help refer the patient for further in-depth screening (Grand Canyon University, 2018). Assessing the patient’s household situation, support systems, and their ability to complete activities of daily living should also be incorporated into the exam.
Elder Abuse and Neglect. (2019, June). Retrieved from https://www.helpguide.org/articles/abuse/elder-abuse-and-neglect.htm
Elder Abuse. (2018, June 8). Retrieved from https://www.who.int/news-room/fact-sheets/detail/elder-abuse
Grand Canyon University (Ed). (2018). Health assessment: Foundations for effective practice. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/
Topic 5 DQ 2: Topic 5: Health Assessment of the Older Adult
End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.