nursing
Practical Nursing
PRN 1253LL Gerontological Nursing Clinical SLO 2
Clinical Day 2-Student Worksheet
Read the indicated chapters below before clinical and complete the text-related questions. Complete the “at clinical” section during the clinical experience. Remember to site your resources in-text and at the end of the assignment on a reference page. Complete the “post-clinical” section at home after your clinical experience.
Chapter 23
1. You are helping with a community class about the signs of stroke and what to do. What is the most important message that you want to send to the participants?
2. Consider the things you can do in your life to reduce your risk of stroke. Make a list of strategies to reduce your risk.
3. List strategies to optimize communication with clients who have communications difficulties as a result of a neurological problem.
AT CLINICAL: Utilize the following website to help you complete a stroke risk assessment.
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POST CLINICAL:
1. Utilize the website above and write out the acronym “BEFAST” and explain what it means.
2. Search the website. How are strokes preventable?
3. Search the website. What are signs/symptoms of a stroke?
4. Search the website. What are factors associated with stroke risk?
5. Search the website. Define a stroke in your own words.
Chapter 24
1. List the three most common mental health disturbances that older adults are likely to experience.
2. How does your culture view depression?
3. What behaviors are indicative of suicidal intent for an older adult?
4. How would you address the use of alcohol and medications to your older adult client?
AT CLINCIAL: Geriatric Depression Scale (GDS) and Patient Health Questionaire-9 (PHQ9). Find a resident and complete a GDS assessment on them. Report your findings to the nurse if the patient scores >5.
Geriatric Depression Scale (GDS) Don’t do this section
Instructions: Circle the answer that best describes how you felt over the past week. Score 1 for each bolded answer.
1. Are you basically satisfied with your life? yes no
2. Have you dropped many of your activities and interests? yes no
3. Do you feel that your life is empty? yes no
4. Do you often get bored? yes no
5. Are you in good spirits most of the time? yes no
6. Are you afraid that something bad is going to happen to you? yes no
7. Do you feel happy most of the time? yes no
8. Do you often feel helpless? yes no
9. Do you prefer to stay at home, rather than going out and doing things? yes no
10. Do you feel that you have more problems with memory than most? yes no
11. Do you think it is wonderful to be alive now? yes no
12. Do you feel worthless the way you are now? yes no
13. Do you feel full of energy? yes no
14. Do you feel that your situation is hopeless? yes no
15. Do you think that most people are better off than you are? yes no
Total Score =
A score of > 5 suggests depression Total Score
Ref. Yes average: The use of Rating Depression Series in the Elderly, in Poon (ed.): Clinical
Memory Assessment of Older Adults, American Psychological Association, 1986
Patient Health Questionaire-9 (PHQ9) Don’t do this section
The PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.
Over the last 2 weeks , how often have you been bothered by the following problems?
Not at all – Scores 0 / Several days – Scores +1 / More than half the days – Scores +2 / Nearly every day – Scores +3
1.Little interest or pleasure in doing things
b. Several days. +1
c. More than half days. +2
d. Nearly every day +3
2.Feeling down, depressed or hopeless
a. Not at all. +0
b. Several days. +1
c. More than half days. +2
d. Nearly every day +3
3.Trouble falling asleep, staying asleep, or sleeping too much
a. Not at all. +0
b. Several days. +1
c. More than half days. +2
d. Nearly every day +3
4.Feeling tired or having little energy
a. Not at all. +0
b. Several days. +1
c. More than half days. +2
d. Nearly every day +3
5.Poor appetite or overeating
a. Not at all. +0
b. Several days. +1
c. More than half days. +2
d. Nearly every day +3
6.Feeling bad about yourself - or that you’re a failure or have let yourself or your family down
a. Not at all. +0
b. Several days. +1
c. More than half days. +2
d. Nearly every day +3
7.Trouble concentrating on things, such as reading the newspaper or watching television
a. Not at all. +0
b. Several days. +1
c. More than half days. +2
d. Nearly every day +3
8.Moving or speaking so slowly that other people could have noticed. Or, the opposite - being so fidgety or restless that you have been moving around a lot more than usual.
a. Not at all. +0
b. Several days. +1
c. More than half days. +2
d. Nearly every day +3
9.Thoughts that you would be better off dead or of hurting yourself in some way
a. Not at all. +0
b. Several days. +1
c. More than half days. +2
d. Nearly every day +3
PHQ-9 score obtained by adding score for each question (total points)
Interpretation:
· Total scores of 5, 10, 15, and 20 represent cut points for mild, moderate, moderately severe, and severe depression, respectively.
· Note: Question 9 is a single screening question on suicide risk. A patient who answers yes to question 9 needs further assessment for suicide risk by an individual who is competent to assess this risk.
AT CLINICAL:
1. If the patient scores positively on either the GDS or PHQ-9, what does this facility do for their patients?
2. What is the facilities policy on if a patient answers “yes” to question #9 on the PHQ-9? (suicide risk).
POST CLINICAL:
Mrs. Andrews, a 68-year-old female, is admitted to the medical/surgical unit with acute cystitis. She has a history of type 2 diabetes, hypertension, osteoporosis, and coronary artery disease. She has a 60-pack-year history of smoking and states she usually has a glass of wine at night to help her sleep. Admission laboratory work from the morning reveals a WBC count of 12.5 × 109/L, hemoglobin of 10.5 g/dL and hematocrit of 32%, MCV 105/dL, platelet count of 150 × 109/L, BUN 27 mg/dL creatinine 1.8 mg/dL, sodium 145 mmol/L, GGT 100 U/L, ALT 110 U/L, AST 96, and albumin 3.0 g/dL. While making hourly rounds, the nurse notes Mrs. Andrews is awake and restless at midnight. The nurse checks her vital signs and records a blood pressure of 150/88 mmHg, heart rate of 115 beats per minutes, respirations of 18 breaths per minute, and a temperature of 99.1ºF. Mrs. Andrews states she has an upset stomach and can’t get comfortable because of the noise “from her neighbor’s constant partying.”
Which interventions should the nurse include to best address the client’s needs?
Chapter 25
1. What are the differences between delirium, dementia, and depression?
2. What are risk factors for development of delirium?
3. List communication strategies for clients experiencing delirium.
POST CLINICAL:
1. Research and describe the mini-cog assessment. You may copy and paste a PICTURE only. Describe the assessment and what it is used for in your own words.
POST CLINICAL:
Mrs. Landers is a newly admitted long-term care resident. She is 88 years old and has late dementia. In addition to Alzheimer’s disease, her medical history includes hypertension, coronary artery disease, depression, and osteoporosis. The move to long-term care was planned when Mrs. Landers dementia was mild. She participated in the selection of the facility, along with her three children. She regularly wanders in and out of other resident’s rooms, picking up objects and putting them down. The assistive personnel gently guide her out of the other residents’ rooms without resistance when this happens and she smiles and repeats “yes” over and over. At 3 p.m. each day, she goes to the door and tries to leave; when assistive personnel or the nursing staff try to steer her to a diversional activity, she says, “no, no, no,” pinches them, and resists redirection. Mrs. Landers eats finger foods as she wanders. She is incontinent of bowel and bladder. Her medications include memantine 10 mg twice daily, donepezil 10 mg at bedtime, fluoxetine 20 mg daily, aspirin 81 mg daily, ezetimibe 10 mg daily, valsartan/hydrochlorothiazide 160 mg/25 mg daily, and acetaminophen 500 mg every 4 hours as needed for pain. Her admission laboratory results reveal the following:
• Hemoglobin 11 mg/dL; hematocrit 34%
• WBC 8.2 × 109/L
• BUN/Creatinine 24 mg/dL and 1.4 mg/dL
• Na/Cl 144 mmol/L and 103 mmol/L
• Glucose 100 mg/dL
• Urine is amber and clear, pH 5.0, nitrite negative and leukocyte esterase trace, blood negative, WBC 1/hpf, and bacteria trace
Which actions will the nurse take to address the client’s most pressing needs? Select all that apply.
1. Request the family schedule an appointment with the facility’s contracted psychiatrist.
2. Put client on a toileting program to reduce incontinence.
3. Request dietary consult to ensure adequate intake to meet caloric needs.
4. Call the health care provider for antibiotic orders to treat a urinary tract infection.
5. Call the health care provider for as needed lorazepam to treat agitation.
6. Call the client’s children to determine previous activities that took place around 3 p.m. daily.
7. Schedule meaningful activities for the client to promote cognitive stimulation.
8. Complete a behavioral diary over a 2–3-day period.
Complete During Clinical:
HEAD TO TOE Assessment Data
This is data that you collected while caring for your patient (It is not to be information from other nurses). Use appropriate abbreviations and terminology. Remember, if something is out of the normal, you may need more assessment!
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Vital Signs: Can use height and weight from patient’s chart, the rest of the VS you should be taking. |
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Blood Pressure: Heart Rate: Oxygen: Temperature: Respirations: Pain: Weight: Height: |
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PAIN: If they do not have pain, list out one of the PRN pain medications and what they take it for. |
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Location:
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Intensity: (pain scale): |
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Alleviating Factors, treatments, and PRN medications:
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Neurological Status |
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LOC (alert and oriented to person, place, time, situation A & O x 4 confused, etc.):
Speech (clear, appropriate, inappropriate): Glasgow Coma Scale Score - Eye-Verbal-Motor Score: Please write this out and tell me why you chose this score: · Eye: · Verbal: · Motor: Pupils: PERRLA? · Pupil size before light: · Pupil size after light:
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Musculoskeletal System |
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Bones, joints, muscles (fractures, contractures, arthritis, spinal curvatures, etc.), extremity circulation checks (pulses, temperature of skin, sensation, edema):
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Cardiovascular System |
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Pulses (both radial and pedal): Capillary refill (<3 seconds): Edema (pitting vs. non-pitting, 0-3+): Neck vein distention: Heart sounds (S1 S2 heard, rate & rhythm): Chest pain: Yes/No |
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Respiratory System |
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Respiratory Rate, Depth, rhythm: Accessory muscles: Oxygen/ flow rate: Pulse Oximeter: Smoking: Lung Sounds: |
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Gastrointestinal System |
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Abdomen: inspect, auscultate, percuss & palpate: Symptoms: Bowel sounds: Last BM: Do they have an ostomy, if so provide description: |
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Genitourinary |
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Last bowel movement: Incontinence of bowel: Incontinence of bladder: Products used: Do they have a catheter, if so provide description: |
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Skin and Wounds |
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Color & turgor of skin: Rash/ bruises: Wounds: Dressings: Sutures:
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Eyes, Ears, Nose, Throat (EENT) |
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Eyes (redness, drainage, edema, irritation, light accommodation):
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Ears (drainage, external ear intact): |
Nose (redness, drainage, edema): |
Throat (sore, color):
Mouth (teeth visualized, dentures, pain, cavities): |
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Psychosocial and Cultural Assessment |
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Cultural Background:
Religious Preference:
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Home Environment:
Marital Status:
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Nursing Interventions Based on your assessment and reading, write 6 nursing interventions. |
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List one educational needs for your patient, the plan to meet these needs, and practical ways to you can assess the effectiveness of your teaching as well as barriers to Learning
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