post 1/2

Respond to at least two of your colleagues on two different days in one or more of the following ways:

· Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues’ patients.

· Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.

· Explain other health promotion considerations for patients in this population or with related issues. ( each response 2 citations / references APA style )

Post 1/ colleagues

The provided case study for this discussion describes an 81-year-old male named Mr. Perkins who presents to the clinic for a routine physical examination. Mr. Perkins initially reports that he is doing well, and the only previous medical condition is osteoarthritis for which he takes Tylenol. Observation of the patient ambulating to the exam room revealed a new finding of right hip pain that has progressively worsened over the past 6 months. Mr. Perkins is utilizing a cane in his right hand to attempt to help reduce the right hip pain. The patient is also requesting a flu shot.

The assessment for Mr. Perkins would begin with gathering HPI from the patient regarding the onset of increased hip pain. Identification of injury or etiology of current issue should be explored. A physical examination would then be conducted as well as a focused musculoskeletal examination due to reported hip pain and past medical history of osteoarthritis. The focused examination for would test the patient’s current range of motion of his extremities, palpate for deformities, tenderness and edema, his gait and balance, and assess his upper and lower extremity muscle strength and reflexivity.

Additional Testing

Choosing the appropriate assessment of pain tool such as the Iowa Pain Thermometer, the Numeric Rating Scale, and the Faces Pain Scale-Revised should be based off the cognitive and physiological ability to communicate effectively is important as there is variability of function with older adults. “Pain can result in functional impairment, sleep disturbance, reduced socialization, depression, reduced mobility, and impaired or slowed rehabilitation” (Hosseini et al., 2022). For older patients, the evaluation of pain can be additionally difficult due to cognitive impairment or communication issues, thus inhibiting the expression of pain (Hosseini et al., 2022). As the patient in this case scenario able to verbalize his discomfort, the numeric rating scale should be appropriate.

The risk of falls is much higher with older adult patients. Experiencing pain with movement, decreased range of motion, polypharmacy, and decreased balance are all factors that place our patients at increased risk. The STEADI (Stopping Elderly Accidents, Death & Injuries) is an applicable tool to evaluate a patient’s risk of falls that provides a method according to fall prevention guidelines of identifying factors related to an increased risk of falls (Emerson, 2022). It may be beneficial to have family members present when evaluating fall risk factors and ADLs. Older patients may initial dismiss symptoms or perceive them as normal due to aging, but family members can remind patient of specific difficulties that they witnessed to aid in gathering a complete history.

While it may be easy to relate the hip pain with the patient’s current diagnosis of osteoarthritis, it is important to eliminate associated differential diagnoses. Joint pain can also be caused by gout, pseudogout, psoriatic arthritis, connective tissue disease, Reiter’s disease, multiple myeloma, scleroderma, lupus, septic arthritis, polymyalgia rheumatic (PMR), cervical radiculopathy, fibromyalgia, and spinal stenosis (Kennedy-Malone et al., 2019). Diagnostic testing could include CBC with differential to rule out infection, an ESR to evaluate an inflammatory process, and a right hip x-ray to check for any fractures.

Limitations

Each of these assessments are appropriate for older adults. The patient’s functional ability to demonstrate range of motion and test for muscular strength, however, are dependent upon the patient’s current activity level and health. Lack of mobility due to comorbidities and guarding of area of pain can greatly affect the older patient’s ability to perform these tests. Gathering a baseline of the patient’s activity level and comparing joints bilaterally for reduced ROM and deformity would be necessary during the examination.

Vaccination Considerations

Mr. Perkins is at the clinic for his annual wellness visit. It is the responsibility of the provider to ensure that the patient has been provided with appropriate preventative treatment during the visit. According to the CDC (2022), adults 65 and older should receive influenza vaccine annually, a PCV13 and PPSV23 vaccine for pneumonia prevention one year apart, 2 doses of Shingrix for shingles prevention 2-6 months apart, and remain up to date on the Tdap vaccine with a booster every 10 years. Additionally, the CDC (2022) recommends COVID-19 vaccination as well as appropriate boosters for elderly patients.

References

Centers for Disease Control and Prevention. (2022, February 17). Adult immunization schedule by vaccine and age group. Centers for Disease Control and Prevention. Retrieved August 30, 2022, from https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html

Emerson, P. N. (2022). Fall-Risk Assessment and Intervention to Reduce Fall-related Injuries and Hospitalization among Older Adults. The Journal for Nurse Practitioners. https://doi.org/10.1016/j.nurpra.2022.07.005

Hosseini, F., Mullins, S., Gibson, W., & Thake, M. (2022). Acute pain management for older adults. Clinical Medicine, 22(4), 302–306. https://doi.org/10.7861/clinmed.22.4.ac-p

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Symptoms and syndromes. In Advanced practice nursing in the care of older adults (2nd ed., pp. 34–94). F. A. Davis. 

Post 2 / colleagues

Osteoarthritis Evaluation Plan

Osteoarthritis (OA) is one of the most prevalent joint diseases affecting the geriatric population. It’s the most common, chronic, and degenerative type of arthritis. Globally, more than half of the elderly aged 65 and above suffer from some form of OA (Metcalfe et al., 2019). The high prevalence rates suggest a need for evidence-based evaluation and assessment of patients with the disease.

Where the evaluation should take place

Patients presenting with suspected musculoskeletal diseases including OA should be evaluated by the hospital’s rheumatology department. The department has the appropriate technical know-how, equipment, and resources to intervene in bone and joint-related complications.

Other Professionals to Consult

A physical therapist would help teach the patient appropriate exercises to strengthen muscles around the hip joint to reduce pain and increase flexibility. Gentle exercises such as walking and swimming could prove to be effective once the assessment confirms OA. Other professionals include occupational therapists to guide on possible activities that may be putting extra stress and strain on the hip joint (Mardones et al., 2017). A radiologist may also be required to interpret imaging when x-rays and MRI scans are used to confirm OA.

Appropriate Assessment Tool

This evaluation plan recommends adopting the Arthritis Impact Measurement Scales (AIMS) assessment tool in evaluating Mr. Perkins. The AIMS evaluation tool is a disease-specific measurement tool recommended for osteoarthritis patients to assess the impact of disease and the outcome of care interventions (AIMS, 2022). This tool assesses physical activities such as walking, lifting, bending, dexterity, mobility, and pain. A more age-specific GERI-AIMS tool is validated for assessing the geriatric population, to which Mr. Perkins belongs.

Assessment Administration Issues  

The language barrier is addressed under the GERI-AIMS assessment tool. The tool has been translated into several languages including French, Spanish, Canadian French, Turkish, Italian, and Portuguese languages. The translation helps to address language issues that may arise during evaluation. GERI-AIMS does not require training for administration purposes (AIMS, 2022). The tool is available for use along with the user manual. 

Immunization

As part of the evaluation plan, Mr. Perkins would be advised to take the flu vaccine annually in September or October (autumn) consistent with the CDC recommendations. Infections caused by flu may trigger an inflammation response that exacerbates the osteoarthritis flare and associated pain in the right hip (Abdelahad et al., 2021). Flu vaccination, therefore, minimizes the risk of inflammation in the hip joints. Besides the flu vaccine, Mr. Perkins would also be advised to take the pneumococcal vaccine if he is yet to get one. This type of vaccine is vital for a patient with any inflammatory arthritis or systemic inflammation targeting joints (Abdelahad et al., 2021). Furthermore, painkillers such as Tylenol reduce the body’s immunity (Gerriets et al., 2018). Comorbidities decrease natural body defenses putting geriatric patients with osteoarthritis at risk of pneumococcal diseases.

 

References

Abdelahad, M., Ta, E., Kesselman, M. M., & Beckler, M. D. (2021). A review of the efficacy of influenza vaccination in autoimmune disease patients. Cureus, 13(5). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197698/

Arthritis Impact Measurement Scales (AIMS). (2022). American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Rheumatologist/Research/Clinician-Researchers/Arthritis-Impact-Measurement-Scales-AIMS

Bancos, S., Bernard, M. P., Topham, D. J., & Phipps, R. P. (2009). Ibuprofen and other widely used non-steroidal anti-inflammatory drugs inhibit antibody production in human cells. Cellular immunology, 258(1), 18-28.

Gerriets, V., Anderson, J., & Nappe, T. M. (2018). Acetaminophen.

Mardones, R., Jofré, C. M., Tobar, L., & Minguell, J. J. (2017). Mesenchymal stem cell therapy in the treatment of hip osteoarthritis. Journal of hip preservation surgery, 4(2), 159-163.

Metcalfe, D., Perry, D. C., Claireaux, H. A., Simel, D. L., Zogg, C. K., & Costa, M. L. (2019). Does this patient have hip osteoarthritis?: the rational clinical examination systematic review. JAMA, 322(23), 2323-2333.