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Prepared by: Suhaib sawafta Salah khalilia Muhammad Nabeel Muhammad Bani Oudi Maha Alyosuf Introduced to: Miss Shurouq Qadous . PHYSICAL ASSESSMENT. A head-to-toe physical examination should follow the health history and a complete review of systems.
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Prepared by: SuhaibsawaftaSalahkhalilia Muhammad Nabeel Muhammad BaniOudi MahaAlyosuf Introduced to: Miss Shurouq Qadous PHYSICAL ASSESSMENT
A head-to-toe physical examination should follow the health history and a complete review of systems. • The physical assessment begins with the evaluation of vital signs.
Because of the potential for orthostatic hypertension, blood pressure should be evaluated in three different positions: sitting, immediate standing, and one-minute standing, especially if the older adult is currently taking antihypertensive medications.
Decreases in blood pressure of more than 20 mm Hg, are indicative of orthostatic hypertension and require further evaluation.
Respirations should fall within the normal range of 12 to 18 bpm with regular heart rates averaging between 60 and 100 bpm. • The temperature response to infection among older adults varies greatly; some older adults respond to infections with elevated temperatures and others with aggressive infections show no febrile response.
Gathering information on clients’ weight and height is also essential to develop a baseline for further comparison of nutritional and hydration levels, as well as bone loss. • BMI less than 25 are considered ideal and should be measured when possible.
Following the gathering of vital signs, a head-to-toe physical assessment is necessary. • The client’s skin should be evaluated for any unusual findings, including: cherry hemangiomas, liver spots, skin tags, keratoses, and precancerous and cancerous lesions,herpes zoster and decubitus ulcers.
Hair growth and nails should be assessed for uniformity and fungal infections. • Evaluation of the head and neck for the presence of lesions or trauma and evaluation of the sclera for whiteness and a notation of the arcus senilis, if present. • Evaluation for cataracts and macular degeneration should also be conducted.
Visual acuity declines as people age, so evaluation of vision and proper referral to an ophthalmologist for follow-up of abnormal findings of the eye should occur. • Tympanic membrane and the light reflex in the ear should be identified, and an evaluation of hearing should be conducted.
The nose should be palpated for tenderness and signs and symptoms of infection. • The mouth and teeth should also be evaluated for deviations from normal, and referrals should be made to a dentist for further management of mouth and tooth disorders.
The thyroid gland should be palpated for enlargement and nodules. • Evaluation of the heart and lungs begins with the evaluation of the carotid arteries and jugular beings in the neck.
The carotid arteries should be symmetrical, nonbounding, and absent of bruits and adventitious sounds, jugular veins should not be distended. • The heart should be inspected and auscultated beginning at the apex for any adventitious sounds.
The lungs should be inspected and palpated for tactile fremitus, hyper-resonance, dullness and equal expansion. • Inspection and palpation of the musculoskeletal system should begin at the temporomandibular joint and proceed inferiorly to the feet for abnormalities, tenderness, bilateral equality, strength, and range of motion.
The abdomen should be inspected for abnormal scars , pulsations, or distention, and bowel sounds should be auscultated in all four quadrants. • Older women should also be examined for breast masses and gynecological abnormalities, and older men should undergo an annual examination for prostate enlargement or malignancies.
An important part of the physical exam is the evaluation of laboratory tests. • Requires both knowledge of the normal ranges for age and the nurses’ awareness of the clients’ health and medication history.
Altered lab values often put them at risk for the development of disease. • For example, an increase in glucose as part of the normal aging process likely plays a role in the high incidence of Type 2 diabetes among older adults. • A decrease in serum calcium plays a role in the higher risk of older adults for osteoporosis.
In addition to lab values, it is important for nurses to understand the normal physiological changes associated with aging and compare them with abnormal change detected in organ systems. • Misidentifying an age-related change as disease-induced may lead to therapeutic attempts to reverse normal aging.
Conversely, incorrectly assuming it is an age-related change may lead to therapeutic neglect of potentially or possibly treatable conditions. • For example, one of the common myths of aging is that all older adults are cognitively impaired. While becoming cognitively impaired as one ages is of large concern to the aging population and their families, many older adults live well into their 10th decade with high cognitive and intellectual functioning as they were in their twenties and thirties.
Memory losses are common in older adulthood, but the development of dementia is not a normal change of aging.
Altered presentation of illness is another challenge in the physical assessment of older adults. • Diseases may present with atypical clinical signs and symptoms that can be confusing.
Severe, acute illnesses will often present with nonspecific or vague symptoms. • Typical signs and symptoms may be absent, such as a cough in an older adult with pneumonia.
At other times, disease may present merely as failure to thrive, changes in mental status, falls, anorexia, or self-neglect. • So, all health care providers need to be aware of these differences.
