PGAP assessment

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Part 2. Data Collection Sheet / Intake Form (20 points)

Client Initials: SR M/F: Female Age: 82 Student: Delaney Gagnon Date: 6/2/22

NOTE: Insert data into the table using short responses and/or bullets; Use medication terminology as if documenting in a medical record. Word process right in the table cells and let the paper expand as needed. Do not remove the table format, alter questions, or try to submit the assignment into an alternative format.

Introduction

Questions to ask

your client:

(use client’s words)

1. Would you rate your current state of health as excellent, good, fair, or poor?

• Excellent

2. Why did you select this rating?

• Only taking a few medications

• Able to cut own grass, cook own meals, be in her own home

• Goes to gym

• Has family and friends

• Has faith

• Plays piano and organ for church

3. What does it mean to be healthy as you age?

• Very meaningful

• Watched husband’s health go downhill

• Independence is very important

• Staying in house as long as possible

1. Medications

Medication, Dose, Frequency

Diagnosis/

Indication

Effective for

condition?

Drug

Duplication?

Side Effects and/or

Lab

Beers

List?

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-prescription & over the counter NOTE: cross- reference meds with problem list & Beers List and/or Medication Appropriateness Index found in D2L Mod.2 Lesson articles. Polypharmacy: consider side effects & drug-drug interactions, effectiveness, Risk/benefit, etc.

(Y-N) (Y-N) Monitoring (Y-N)

1. Fexofenadine 180mg q.d. 2. Omeprazole 20mg q.d. 3. Fluticasone PRN 4. Pravastatin 20mg q.d. 5. Calcium 600mg q.d. 6. Vitamin D3 1000 IU 7. Acetaminophen 650mg q.d. 8. Melatonin 5g q.d. 9. Latanoprost 1 drop per eye q.d. 10. Ibuprofen 200mg PRN 11. Cetirizine 5mg PRN

1. Seasonal allergies

2. Acid reflux 3. Seasonal

allergies, nasal congestion

4. High cholesterol

5. Bone strength 6. Deficient,

calcium absorption

7. Arthritis pain 8. Sleep aid 9. Glaucoma 10. Arthritis pain 11. Seasonal

allergies

1. Y 2. Y if taking

consistently 3. Y 4. Y – was

able to reduce dose

5. Y 6. Y 7. Y 8. Y 9. Y 10. Y 11. Y

1. N 2. N 3. N 4. N 5. N 6. N 7. N 8. N 9. N 10. Y – only

uses when she needs additional relief

11. Y – only uses when she needs additional relief

1. Fluid intake, renal labs

2. Bowel function, black tarry stools, diarrhea

3. Adrenal function, otolaryngologic exams to monitor nasal mucosa

4. CK levels if muscle tenderness present

5. Calcium level 6. Vitamin D level 7. Hepatic and

renal labs, skin assessment

8. Dependence 9. Irritation 10. Bowel

function, renal labs

11. Skin checks and dizziness

1. N 2. N 3. N 4. N 5. N 6. N 7. N 8. N 9. N 10. N 11. N

Client Findings 2. Identify medical problems based on Review of Body Systems and their functional impact.

Review of Systems/Current Medical Problems

1. Cardiovascular- high cholesterol

2. Respiratory- seasonal allergies, vocal hoarseness

3. Gastrointestinal- acid reflux

4. Genitourinary- none

Any Impact on Function? (describe)

no, managed well with diet and medication

yes, limit time outdoors and difficulty with social

interactions due to voice

no, managed well with consistent use of omeprazole

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-Refer to Mauk Ch. 6- Functional Assmt or Independent Activities of Daily Living (IADLs)

5. Neuro/Mental Health- forgetfulness

6. Musculoskeletal- osteoarthritis

7. Immune- none

8. Hematic/Blood- varicose veins

9. Integumentary- none

no

no

yes, painful hands sometimes make it difficult to do

housework and activities

no

no

no

3. Previous surgeries and/or health problems

• Mild-moderate COVID-19 infection in 2021

• Hernia repair surgery in 2019

• Fall with concussion in 2019

• No others noted by SR in recent years

4. Education level, Occupation & age at retirement-

• Attended high school through junior year

• Completed GED

• Had 4 children by age 22

• Stay at home mom

• Kindergarten paraprofessional for 16 years

• Nurse scheduler for nursing home 15 years

• Worked until age 70 part-time

• Currently plays organ/piano every Sunday at her church

5. Recent and impending life changes (deaths, moves, stressors, hospitalizations, COVID?)

• Recently sold trailer home in AZ; this will be first full winter spent in MN in many years

• Husband passed away in 2018

• Son passed away in 2015

• Moved to town with family in 2017

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6. What activities engaged in to maintain or improve health? How does this affect their personal and social functionality?

• Goes for walks daily

• Eats balanced diet

• Drinks alcohol in moderation and does not smoke

• Attends water aerobics or swims in lake b.i.w.

• Attends yoga at gym every Monday

• Does word puzzles, stitching and sewing

• Cooks and bakes for self, family, and neighbors

• These activities allow SR to exercise her body and mind. Some of these activities, such as going to fitness

classes, allow her to interact with friends and members of her community while improving her health.

7. Current and future living environment and its appropriateness to ADL function and long-term prognosis? How does it contribute to their health? Is it appropriate? Any safety concerns? (stairs, handrails, shower chair, throw rugs, clutter, laundry, etc.)

• SR would like to stay in her current home as long as possible

• Everything she needs is on one floor

• Has high rise toilet and new, lower mattress

• In process of improving front steps so they are lower and have option to add a ramp

• Daughter lives about 5 minutes away, helpful neighbors

• Living environment is appropriate for current health status

• In future, will possibly need to add a ramp instead of front steps

• Door to detached garage a safety risk; in 2019, wind caught door and SR fell down the stairs

• Inside stairs nearby main entry to house risk for falls

• Home well-kept with minimal clutter

8. Family situation and availability. Provide details. (where they live, how often they visit, what they help with, etc)

• Daughter lives five minutes away; sees or talks to daughter every day

• One son lives 15 minutes away; sees about every other week

• Other son lives 40 minutes away; sees about every other week

• “If I need them here, they’re here in a minute.”

• Children help with home improvements, washing windows, heavy lifting, car maintenance, etc.

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• Children “won’t allow me to be on a ladder” and tell SR to “slow down when she’s walking”

• Children are all involved in SR’s finances; SR does not make a big purchase without their input

9. Current caregiver network including its deficiencies and potential for improvement.

• Children and neighbors help SR when she needs help carrying heavy items or tasks that involve climbing a

ladder

• SR has long-term insurance that has options for home health

• SR is unsure exactly how home health care much they would provide

10. Objective measure of cognitive status, forgetfulness, affect & mood, etc. Explain.

• SR answers questions appropriately and incorporates humor at times

• Positive outlook on life and states she is grateful to wake up each morning

• States she feels forgetful at times; can’t find keys, doesn’t remember names as well, spends more time

looking for things

11. Objective assessment of mobility, balance, previous falls, ability to drive a car. level of physical activity. Explain.

• Extremely active for age; this week, she took more than 15,000 steps on two separate days

• SR feels her balance could be better and she is aware of this deficit when going down the stairs; goes to yoga

on Mondays to work on this

• Still drives car cautiously and knows her family will tell her when she is no longer safe to drive; she states

she is “not looking forward to that day”

12. Rehabilitative status, prognosis, how long they can be expected to stay in current living situation? Assistance or home modifications needed?

• SR would like to stay in home as long as possible

• She is accepting of home care assisting her as needed as she ages

• Children are currently helping modify her front stairs to make the steps shorter and less slippery in the

winter; also creating option to add a ramp

• Side stairs to garage also need to be modified and perhaps a different door style that opens inward, so the

wind doesn’t catch it

• Interior currently safe for SR; no clutter, clear walkways, raised toilet, everything on one floor

13. Current emotional/mental

• Good emotional and mental status

• Practices self-care, such as gratitude journaling

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health and substance use/abuse? Explain.

• Strong faith helps her through difficult life events

• Drinks a glass of wine b.i.w.

14. Religious affiliation & significance. Explain.

• SR is a practicing Lutheran

• “I couldn’t do anything in the world without my faith”

• Considers herself a “true believer”

• Does devotions every morning and feels it is a privilege to be asked to pray for others

• SR states she couldn’t have made it through loss of her son without faith

• Attends bible study group

• Plays piano and organ at mass each Sunday

• Tries to give and help as much as she can

15. Nutritional status, Ht/Wt BMI Calculator, who grocery shops, what do they have in the fridge/cupboards, who cooks, describe typical meals? Community resources? Explain.

• Considers herself a “boring eater”

• Eats homemade egg puff or yogurt for breakfast

• Salad with protein such as nuts, chicken, or salmon for lunch

• Dinner is usually “pretty light,” such as fish, rice, and a vegetable

• Enjoys eating fruits and vegetables

• Drinks decaf coffee, lots of water, and herbal tea at night

• SR usually buys her own groceries

• Sometimes will have her daughter pick up a couple items from Costco

• Enjoys baking and sharing with family, friends, and neighbors

• Drinks a glass of wine a couple times per week

• BMI is 24.4

16. Preventive health, immunizations, screenings, and health promotion

Immunizations

Click below:

Vaccines for Elders

Screenings

Click below:

Screenings Older Adults

Health Promotion

Click below:

Conversation Starter

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activities.(include dates) CLICK on the Resource content tabs & apply to your client. **if no dates, include a plan to address deficit on the Health Promotion problem list & significant intervention in the section below.

Vaccines to consider: Pneumococcal – yes, around 2010; had severe reaction to it, possibly cellulitis but pt unsure Tetanus – 2019 after fall down stairs Zoster – yes, “had the old one,” unsure of year Flu – gets every fall COVID – had first two doses in early 2021; wants to talk to her PCP before getting booster

Screenings to consider: Depression – doing well, performed TRY THIS depressing screening during assessment

Mammogram – appointment for one in a couple weeks Diabetes-HTN – sees PCP every fall and is screened Hearing/Vision – vision being monitored, being treated for glaucoma; needs another hearing screening as SR has noticed a decline Hepatitis C Others…

Other areas to ask about: Alcohol – uses in moderation Drug use – never used Smoking – never smoker Dentist – regular cleanings Eye Exam – glaucoma, being monitored; getting eye pressure checked again in coming months Advanced Directive (Ask -What Matters Most if health declines) – has an advanced directive; has copies with doctor and children, so everyone is aware of her wishes

17. Services & resources. (home care, Soc.Security, pensions, health insurance, community programs). Explain.

• Has social security and pension from late husband’s career

• Has long-term health insurance

• Home care is an option as SR gets older and may need more help

• Not currently in need of community programs or services as she is fairly independent and has family

available to assist her

18. Technology available in the home. Describe: (land-line telephone, computer skills, electronic tablet, internet, smart phone, electronic gadgets, electronic banking, Access to Online Medical Record, etc)

• iPhone and iPad

• 2 TVs, no cable

• Internet

• Kindle

• Online banking, automatic billing

• MyChart for medical record

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Concluding Questions to ask your client:

1. What suggestions do you have for others about health in aging?

• Live each day

• Do everything in moderation

• It’s OK to have a glass of wine

• Look after your weight

• Keep your brain working

• Enjoy life

2. What suggestions do you have for nurses/health care providers/NH administrators about health in the elderly?

• Have a lot of patience; “they’re going to tell you a lot more than you need to know”

• Encouraging lifestyle changes and fewer pills

• Encourage people to get outside and be with other people; don’t shut self in or sit around

Part 3: Functional Assessment (5 points)

Select One: SPICES, Lawton, or Katz (Select one-- cannot be used in Section 4)

Try This Tool Description of Tool

include brief description, sample questions, etc.

Pt. Score & Interpretation

Include scoring range, interpretation of score

Frequency of Follow-up and/ or Repeat Screening

1.

Lawton

• Assessment of functional status for older adults

• Evaluates skills more complex than ADLs

• Includes 8 domains of function, including shopping, food preparation, housekeeping,

• Scores range from 0 to 8, with 0 being low function/dependent and 8 being high function/independent

• SR scored and 8, meaning she is high functioning and independent

• Repeat annually or after a major event like illness or injury to determine areas of deterioration or opportunities for improvement

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laundry, transportation, finances, and medications, and telephone use

Part 4: 5 “TRY THIS” Assessments (25 points)

Your goal is to use a tool that will lead to a significant intervention-- use critical thinking and clinical reasoning skills

Try This Tool Description of Tool

include brief description, sample questions, etc.

Pt. Score/ Interpretation

scoring range, and interpretation of range of scores

F/u Intervention needed?

(Yes or No)

1. Geriatric Depression Scale

• Screening for depression as it is common in later life

• 15-item questionnaire appropriate for many settings and types of patients

• Scores of 0-4 are normal, 5-8 indicate mild depression, 9-11 indicate moderate depression, 12-15 indicate severe depression

• SR scored 1 out of 15, indicating normal depending on age, education, and current situation

• No follow-up needed at this time

• Follow-up after major life events such as loss of a family member or friend, or a change in health and independence

2. Heinrich II Fall Risk

• Purpose is to identify adults at risk of falls so interventions can be developed to prevent falls

• Score of 5 or higher indicates high risk for falls

• Reassess annually or with health status changes

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• Includes 8 weighted risk factors and medications that may alter balance and increase fall risk

• SR scored a 0, which indicates that she is not at a high risk for falls

3. Nutrition

• Purpose is to identify older adults who are malnourished or at risk for malnutrition

• Includes 6 screening categories, such as mobility, weight loss, and food intake, to assess nutritional states

• 12-14 points indicates normal nutritional status, 8-11 indicates risk of malnutrition, 0-7 indicates malnutrition

• SR scored a 14, which indicates she has normal nutritional status

• Reassess annually for older adults in community

4. Your Choice TRY THIS only Hearing Screening in Older Adults

• Designed for older adults living in community

• 10-item questionnaire assesses social and emotional effects of hearing loss and perceived disability

• 0-8 points suggests no hearing handicap, 10-24 suggests mild-moderate hearing handicap, 26-40 suggests significant hearing handicap

• SR scored a 10, which indicates a mild-moderate hearing handicap

• Per Try This activity, SR should be referred for additional hearing evaluation

• Contact PCP about repeat hearing test as SR feels it has gotten worse since her last screening

5. Your choice TRY THIS only FACIT Fatigue Scale

• Designed for patients with complaints of fatigue, even if not due to underlying condition

• 13-item questionnaire to measure level of fatigue with daily activities over last 7 days

• Score of less than 30 suggests severe fatigue; higher scores reflect improved quality of life

• SR’s score was 44 out of 52 possible; while she has a high level of independence, fatigue occasionally prevents her from doing everything she’d like

• Reassess annual or with changes to health status

Part 5: Identify Opportunities for Intervention Supported by Data Intake/TRY THIS (10 points)

Students must demonstrate critical thinking to recognize pertinent data (Red-flags) supported by evidence documented in Parts 2-4 above to support a significant intervention in Section 6. Identify supporting data to justify the opportunity. (Do not include new data that cannot be cross-referenced in GAP Sections 2-4)

Focused Area for Intervention Evidence from data intake/TRY THIS screening assessments

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1. Matters Most:

Advanced Directives or Vaccination gap

• Vaccination gaps • Pneumococcal vaccine reaction; unsure if she got one or two doses • Shingrix vaccine • COVID-19 booster

2. Mental Health

Consider socialization, technology or impact of COVID isolation

• Increased forgetfulness in recent years • More difficult to remember names • Misplaces items

3. Medication

Consider polypharmacy (Rx or OTC) & side effects

• Daily acetaminophen use for osteoarthritis pain

4. Mobility-

Consider level of physical activity, fall risk, or driving concerns

• Driving safety and longevity • SR is extremely cautious when she drives • She would like to drive for as long as possible to maintain her independence

5. Meals or Nutritional Status

Consider BMI, diet restrictions for disease & protein consumption

• Eats same meals most days • Good protein and nutrients, but lacks variety in meals

Part 6: SMART goals & Significant Interventions (10 points)

1. Consider your client’s intake data, needs, abilities, limitations, and resources. 2. Identify Evidence-Based and Significant Interventions supported by research & EBP. (Be creative… SMART phone apps, SMART pets, video security cameras, online access to medical records, home grocery delivery) 3. Locate EBP journal articles published in the past 5-10 years to support the intervention. 4. Create patient focused SMART goals that are written in one succinct sentence highlighting the intervention. (S-specific, M- measurable, A-achievable, R-realistic, T-timely)

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Sample SMART goals: Client will get XXX vaccination at the clinic by June 1, 2023. J.R. will access online medical record and print out vaccination record by June 1, 2023.

Opportunities for Improvemement

Significant Intervention Highlighted in the EBP article

SMART goal

1. Matters Most: Focus on vaccination gap or Advanced Directive opportunity

Receive COVID-19 booster, which is shown to help protect against the omicron variant.

In order to protect against COVID-19 reinfection, SR will receive the COVID-19 booster at clinic by July 31, 2022, with PCP’s approval.

2. Mental Health Focus on socialization, gero- technology, or engagement with their healthcare with EMR access

Incorporating mindfulness medication can improve working memory.

SR will participate in biweekly mindfulness meditation at home or wellness center to improve memory beginning July 1, 2022.

3. Medication Focus on polypharmacy or side effects

Consistently wear arthritis gloves at night to reduce need for daily acetaminophen.

SR will begin wearing arthritis gloves overnight while sleeping to reduce pain and inflammation beginning July 1, 2022.

4. Mobility Focus on level of physical activity, fall risk, or driving concerns

Enrolling in older driver safety courses with tailored driving lessons to improve safety on the road and extend time SR can safety drive her car.

SR will enroll in an older driver safety course with the option to include tailored driving lessons in Minnesota by July 31, 2022.

5. Nutrition

Consider BMI, diet restrictions for disease & protein consumption

Increasing meal variety is shown to increase energy intake in older women with a lesser appetite.

SR will make and eat one new recipe at home every two weeks beginning July 1, 2022.

Part 7: Annotated Bibliography of Evidence-Based Interventions (10 points)

Identify the significant intervention from Section 6 above. Locate an appropriate article from a peer reviewed journal that was published in the past 5-10 years that highlights the Evidence-Based significant intervention. The article must be closely aligned to your significant intervention. Consider the study design (it is more than quantitative or qualitative). The APA reference should be listed in the gray box in the table below. The critical summary should include a brief summary including the research study design, findings, & application to your client. The paragraph may be single spaced, and plan to make full use of the 150 word limit to explain how/why the specific intervention can improve your client’s health. Annotated Bibliography SAMPLE

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ARTICLE #1 – Chenchula, S., Karunakaran, P., Sharma, S., & Chavan, M. (2022). Current evidence on efficacy of COVID-19 booster dose vaccination against the Omicron variant: A systematic review. Journal of Medical Virology, 94(7), 2969-2976. https://www.doi.org/trmproxy.mnpals.net/10.1002/jmv.27697 Critical Summary (150 words, max) Chenchula, S., Karunakaran, P., Sharma, S., & Chavan, M. (2022). Current evidence on efficacy of COVID-19 booster dose vaccination against the Omicron variant: A systematic review. Journal of Medical Virology, 94(7), 2969-2976. https://www.doi.org/trmproxy.mnpals.net/10.1002/jmv.27697 The study by Chenchula et al. (2022) is a systemic literature review that addresses the effectiveness of a COVID-19 vaccine booster to protect against the Omicron variant. The Omicron variant, which has more than 50 mutations, is known to have increased transmissibility and shows resistance to vaccine immunity. This review includes 27 summarized studies. Research showed that overall protection after the two-dose vaccine series went from 80% during the Delta wave to 33% during Omicron. While the risk of hospitalization was lower with Omicron than with the first wave of COVID-19, the risk for reinfection with Omicron was also higher than with previous variants. Many of the 27 studies in this review showed that people who received a booster dose of the COVID-19 vaccine were less likely to have a symptomatic infection or hospitalization compared with unvaccinated individuals or those with the two-dose series only. ARTICLE #2 – Bailey, N., Freedman, G., Raj, K., Spierings, K., Piccoli, L., Sullivan, C., Chung, S., Hill, A., Rogasch, N., & Fitzgerald, P. (2020). Mindfulness meditators show enhanced accuracy and different neural activity during working memory. Mindfulness, 11, 1762-1781. https://www.doi.org/10.1007/s12671-020-01393-8 Critical Summary (150 words, max) Bailey, N., Freedman, G., Raj, K., Spierings, K., Piccoli, L., Sullivan, C., Chung, S., Hill, A., Rogasch, N., & Fitzgerald, P. (2020). Mindfulness meditators show enhanced accuracy and different neural activity during working memory. Mindfulness, 11, 1762-1781. https://www.doi.org/10.1007/s12671-020-01393-8 The study by Bailey et al. (2020) examines the working memory and neural activity of people who practice mindfulness meditation compared to those who do not. This study compared 29 mindful meditators to 29 meditation-naïve individuals, recording electroencephalography during a working memory task. The study showed that the mindful meditators showed improved working memory accuracy and more frontal distribution of activity than those who did no use meditation. Meditators also had a quicker event-related potential response and used less neural response strength

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when using their working memory. While mindful meditators did not have higher levels of working memory activity, it appears that their brains use an alternate pattern of activity when activating the working memory. This indicates that individuals who practice meditation have better working memory with less neural activity, which would benefit SR to prevent forgetfulness as she ages. ARTICLE #3 – Hammond, A., Prior, Y., Cotterill, S., Sutton, C., Camacho, E., Heal, C., Adams, J., Hough, Y., O’Neill, T., & Firth, J. (2021). Clinical and cost effectiveness of arthritis gloves in rheumatoid arthritis (A-GLOVES): A randomized controlled trial with economic analysis. BMC Musculoskeletal Disorders, 22(47), 1-13. https://www.doi.org/10.1186/s12891-020-03917-8 Critical Summary (150 words, max) Hammond, A., Prior, Y., Cotterill, S., Sutton, C., Camacho, E., Heal, C., Adams, J., Hough, Y., O’Neill, T., & Firth, J. (2021). Clinical and cost effectiveness of arthritis gloves in rheumatoid arthritis (A-GLOVES): A randomized controlled trial with economic analysis. BMC Musculoskeletal Disorders, 22(47), 1-13. https://www.doi.org/10.1186/s12891-020-03917-8 While quality evidence for their effectiveness is lacking, compression gloves for arthritis are commonly prescribed. The purpose of compression gloves is to help with pain and inflammation and to improve hand function for individuals with arthritis. The study by Hammond et al. (2021) compared properly fitting Isotoner gloves with loose-fitting placebo gloves with similar thermal qualities. These gloves can also be prescribed for night-time wear to improve sleep and reduce pain and stiffness in the morning. After wearing the gloves for 12 weeks, the intervention and control groups noted similar improvement in their symptoms. More than 70% of participants felt the gloves provided comfort and were beneficial, while 41% reported that the gloves helped them sleep better. While there was not a statistical difference between the groups, the perceived benefit and low cost suggest it would be worth SR consistently wearing arthritis gloves to reduce the need for pain medication. ARTICLE #4 – Anstey, K., Eramudugolla, R., Kiely, K., & Price, J. (2018). Effect of tailored on-road driving lessons on driving safety in older adults: A randomized controlled trial. Accident Analysis and Prevention, 115, 1-10. https://www.doi.org/10.1016.j.aap.2018.02.016 Critical Summary (150 words, max) Anstey, K., Eramudugolla, R., Kiely, K., & Price, J. (2018). Effect of tailored on-road driving lessons on driving safety in older adults: A randomized controlled trial. Accident Analysis and Prevention, 115, 1-10. https://www.doi.org/10.1016.j.aap.2018.02.016 Many older adult drivers are considered “fit to drive,” but have an increased risk of motor vehicle crashes causing injury or death. Older adults who no longer drive often have increased rates of depression, social isolation, health decline, and mortality. However, there is a lack of programs to help improve the safety and skill of older drivers. The randomized controlled trial by Anstey et al. (2018) evaluated the efficacy of individual driving lessons in addition to the traditional rules of the road refresher courses in improving older driver safety.

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The study showed improved safety ratings of both the classroom only and the classroom plus individual driving lessons after three months. Either option is helpful in improving severe driving errors that may increase the risk of driving for older adults. SR may benefit from classroom and tailored driving lessons to be able to remain driving independently for a longer time. ARTICLE #5 – Wijnhoven, H., van der Meij, B., & Visser, M. (2015). Variety within a cooked meal increases meal energy intake in older women with a poor appetite. Appetite, 95, 571-576. https://www.doi.org/10.1016/j.appet.2015.08.029 Critical Summary (150 words, max) Wijnhoven, H., van der Meij, B., & Visser, M. (2015). Variety within a cooked meal increases meal energy intake in older women with a poor appetite. Appetite, 95, 571-576. https://www.doi.org/10.1016/j.appet.2015.08.029 The randomized controlled trial by Wijnhoven et al. (2015) applied the principle that increasing the variety of foods within a cooked meal increases dietary intake to older women with poor appetite. In this study, a control group ate a meal of consisting of one meat or fish, one vegetable and one variety of starch, while the intervention group ate a meal with three meats or fishes, three vegetables, and three starches. The intervention group with greater variety in their meal was shown to have a greater meal intake in both grams and energy. It was shown that the greater the variety in color, taste, and texture, the greater the effects of intake. With this information, it would be advisable for SR to increase the variety of foods she eats each day by incorporate different flavors, textures, and colors in each meal.

Part 8: Self-Evaluation (10 points)

Write a brief summary in APA format that describes ways this assignment has helped you gain experience and confidence in taking a leadership role in client assessment and applying evidence-based practice interventions into the clinical setting. Estimated length 200- 300 words. Single-spaced acceptable to save space.

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As a nurse, I am used to performing assessments on the patients I see in our Ambulatory Infusion Center. Many patients are older adults who experience a multitude of side effects while receiving chemotherapy. While I assess them, sometimes in great detail, I often feel there are limited suggestions I can give for interventions to help with their side effects. I am in the habit of referring them to their oncologist or nurse navigator for further evaluation and treatment. This assignment helped me step into more of a leadership role because it is specific to nursing, and it not about creating referrals to other specialties.

With my assessment of SR, I struggled because she is doing so well for an 82-year-old woman living alone in the community. I really had to get creative in finding interventions that applied to her and that I could implement as a nurse. SR is stoic, so it took more digging for her to open up about what improvements she could make. I found great value in researching some areas of potential interventions and finding evidence-based practices that will help SR remain independent in her home for as long as possible, which is very important to her. I look forward to sharing these suggestions with SR and the evidence behind them.

To submit your final project assignment forms, please save your document with LAST NAME_ assignment title_ date. Example: Stock_Gero Assessment_(date)

GAP Grading Rubric*** For Instructor Use When Grading

Part Assignment Element Possible Points Points Earned

1 Signed Consent (with client phone number) 10 10

2 Data Collection criteria: thorough, organized, succinct (bullets--avoid full sentences)

20 19

3 Functional Assessment choose from: SPICES, Lawton, or Katz criteria: description and interpretation

5 5

4 TRY THIS screening assessments includes: mental health, fall risk, pain, plus 2 more priority needs criteria: include description, interpretation, and address follow-up -5 points per TRY THIS tool

25 24

5 Significant Intervention/Opportunities to Promote Successful Aging supported by evidence on data collection & TRY THIS assessments. - 5 areas x 2 points for each area

10 10

6 SMART Goals- significant intervention aligned with article 10 10

NURS 420: Gero Assessment; p 17 of 17

NURS.420.SU.2022/njs©

5 SMART goals x 2 points each 7 Annotated Bib.

Annotated Bibliography (2 pts/article) -Professional journal published~5yrs, -Aligned with intervention -APA reference & format -Study design, brief summary & application to client. -word count ~150

10 9

8 Self –Evaluation includes: leadership role, client assessment, evidence-based practice criteria: 200-300 words, APA format

10 10

Total Note: up to 5 points may be deducted for grammar, spelling, neatness, Or if no client phone number is provided on consent. Comments: Awesome Job..

100 possible 97