CAMBA, MA. LIEZEL M.

BSN IV-C
ACTIVITY 1 FOR MIDTERMS: Comprehensive Elderly Assessment
1. Data:
Fermin is an 82 year old male client who is also my grandfather. He had a condition
Diabetes Mellitus type 2 and Asthma. He stands about five feet and four inches tall, looks well
with good body posture and weighs about 68 kilograms. Activities are limited due to his
condition easily acquiring illness such as cough and colds when he works too much in the
backyard. He had broken his left hip bone one and a half year ago and is now walking with a
stick as support.
2. Assessment:
2.1) Health Perception / health management pattern: According to Fermin his perception of
health care is tending to his illness quickly by going for checkups, taking the prescribed
medications, eating of nutritious foods, and appropriate body cleanliness. He promotes good
preventions to avoid acquiring illness.
2.2) Nutritional-metabolic pattern: Every breakfast he would drink his milk and eat oatmeal
mixing two boiled eggs in it. In the afternoon and dinner regular dishes such as fish, pork,
chicken, and vegetables are the ulam he eats. Instead of eating rice, he would eat cabbage as
a substitute since eating too many carbohydrates would increase his sugar levels. He also eats
chips, and fruits during merienda in between breakfast and lunch, also merienda in the
afternoon at around 4-5PM.
2.3) Elimination Pattern: In the morning he usually had the urge to eliminate before or after
having his breakfast. He would sometimes have the urge when he ate too much such as in
parties or having too many snacks. He also has a good elimination pattern in terms of excreting
urine. He drinks a lot of water and a good amount of urine can be let out too.
2.4) Activity Exercise Pattern: My grandfather cleans our backyard in the mornings and
afternoons every day. It is part of his exercise and before starting the day in the morning he
would do stretching and jog around the backyard too. He also water the plants using only a pail
and a tabo for scooping water and throwing it on the air to the ground.
2.5) Sleep-rest Pattern: My grandfather had the same sleeping pattern everyday. On the
afternoons he would take a nap from 1PM to 3PM. Every night he would get into bed at eight
and wakes up at six in the morning.
2.6) Cognitive-Perceptual Pattern: In regard of cognitive-perceptual pattern, he had no problems
and hes good in coping with stress. He tends to just go along with the familys flow and spends
times with them. Geriatric are known to have poor eyesight, hearing and slowed movement.
Fermin would strive to do his best to not let this things let him down.
2.7) Self-Perception / Self concept Pattern (Geriatric Depression Scale): There are not much of a
trigger to depress my grandfather except for one thing, my grandmother being far away in
another country. But most of the time, he was happyhe can do many things and he had a
hobby of taking care of chickens (sabong). He also loves joining family conversations and having
meals and snacks with us. He loves keeping the backyard clean and he devoted himself to God.
He doesnt feel lonely, since our family wont let him.
2.8) Role-relationship pattern: Hes a teacher, he encourage, hes hard-working, a loveable and
caring grandfather and father, also someone whos very faithful and strong for his family.
2.9) Sexuality-Reproductive Patter: None since this is too mainstream~
2.10) Coping-stress Tolerance Pattern: When hes not feeling well, he would just stay in his room
for a few minutes to pray in front of the altar. Later on you would see him doing the normal
activities he would do every day. Watching television or reading newspaper and playing mind
games also cheers him up especially when hes bored.
2.11) Value-Belief Pattern: As Fermin stated: I believe in one God, the father almightycreator
of heaven and earth. Think of him, everything he did, everything you have, is a life you should
love and as we all say, God is love. Be good, do good, dont worry, be happy.
3. Fulmer SPICES: An Overall Assessment Tool for Older Adults
Clients Name: Fermin Camba Date: August 16, 2014
SPICES EVIDENCE
YES NO
Sleep Disorders
Problems with Eating or Feeding
Incontinence
Confusion
Evidence of Falls
Skin Breakdown

SPICES
Sleep Disorders there is no present of sleep disorders. His sleeping pattern is well and would
be wake up in an alarm clock or his pattern of waking up early in the morning or even when he
had the urge to pee.
Problems with Eating or Feeding He eats well except that he had to avoid sweets which he
follows strictly thats why he also avoid rice that would further cause his increase in sugar level.
Incontinence He quickly had an urge to defecate in mornings and was only able to hold it for
two to three minutes. His eliminating of urine is good.
Confusion He only gets confuse in situations of not hearing well what he was told and he
would ask questions many times in a day and sometimes he would be reminded more than
three times of things that doesnt really matter, therefore hes not really forgetful, he just ask
things just to open a conversation.
Evidence of Falls He use a stick as a support when hes walking, He had broken his left hip
bone one and a half year ago but now hes not in pain in moving it and was able to cope and get
used to his condition.
Skin Breakdown His lower feet and soles had skin breakdown, also one of the factors is his
condition of having diabetes thats why he had much poorer healing time.







Nursing Care Plan
1. WELLNESS DIAGNOSIS
Assessment The client stated that he exercises every day, had a well balanced diet, and no
disturbance during sleep periods. He can walk with or without using his stick in just enough
distant and he can sweep clean the backyard.
Nursing Diagnosis Wellness diagnosis: Effective self-health management.
Explanation As an 82 year old client, activities are limited, even food and liquid intake and
there are a lot of restrictions. The client strictly follows this health maintenance in order to live
easily and still able to do things by himself.
Objectives
SHORT TERM: After 4 hours of health teaching, client will verbalize acceptance of need and
desire to change actions to achieve agreed-on health goals.
LONG TERM: After 3 days of health teaching, the client will demonstrate behaviors and changes
in lifestyle necessary to maintain therapeutic regimen.
Nursing Interventions and its Rationale
Interventions Rationale
Reinforced well balance diet

Encourage to keep on performing
tolerated and daily exercises
Encourage increase fluid intake
Promote proper hygiene and hand-
washing
Teach ways of relaxation techniques
and coping with stress
Teach ways of safety measures
Encourage adequate rest and sleep
periods
To prevent illness that may trigger his
condition (Diabetes Mellitus
For immobilization and maintaining
proper weight
For good hydration status
For cleanliness and prevention from
illness
Promote good mental condition and
alternative thinking
Elderly clients are more at risk in falls
Saving enough energy for a day



Expected Outcome
SHORT TERM: The client shall verbalize acceptance of need and desire to change actions to
achieve agreed-on health goals.
LONG TERM: The client shall have demonstrated behaviors and changes in lifestyle necessary to
maintain therapeutic regimen.

2. RISK DIAGNOSIS
Assessment The client stated that he is diabetic and asthmatic. He avoids eating too much
sweet but during occasions he would do as he pleases. He tends to his pet chickens and most of
the time he stays in the dusty areas of the chicken coops. These things would trigger his asthma.
Nursing Diagnosis Risk diagnosis: Worsening health conditions
Explanation The problem of the client is keeping his sugar levels normal and avoiding things
that would trigger his allergies. The client both had Diabetes type 2 and Asthma which could be
prevented from worsening if he strictly do health management for himself.
Objectives
SHORT TERM: After 4 hours of health teaching, client will identify basis of his condition and
individual areas of control.
LONG TERM: After 3 days of health teaching, the client will perform activities of the daily living
and participate in desired activities at level of ability.
Nursing Interventions and its Rationale
Interventions Rationale
Decision making and planning for
restricting self from health hazards
Avoid things that would trigger
allergies
Encourage increase fluid intake
Avoid sweets
Perform good exercise
Advise to take medications prescribed
when conditions worsen
Encourage adequate rest and sleep
periods
Prevent further illness caused by
clients condition
As much as possible, refrain to
hobbies that is not good for the health
For good hydration status
To lower sugar levels
Promote good body weight
To help self from further
complications
Saving enough energy for a day
Expected Outcome
SHORT TERM: The client shall identify basis of his condition and individual areas of control.
LONG TERM: The client shall perform activities of the daily living and participate in desired
activities at level of ability.

3. ACTUAL DIAGNOSIS
Assessment The client present health status is well. Mostly his only problems are elimination
pattern, poor hearing and eyesight that can easily be manage and plan for intervention. He
stated that he can only walk slowly and had strict health management of himself.
Nursing Diagnosis Actual diagnosis: Advanced and reinforcing health teachings. Readiness for
enhanced Knowledge.
Explanation Since the client is doing well and like ordinary person, he gets sick in times when
his back is unkempt dry, when he eats something that is not good, or when he refuses to follow
his restrictions of doing things hes not supposed to. Due to his own experience like getting
hospitalized from a broken bone or bronchitis he stated that he learned a lot and promises he
would try his best from acquiring any illness since he stated himself that hes getting old and
there are many limitations in order to live well.
Objectives
SHORT TERM: After 4 hours of health teaching, client will verbalize understanding of information
gained.
LONG TERM: After 3 days of health teaching, the client will use information to develop
individual plan to meet healthcare needs and goals.
Nursing Interventions and its Rationale
Interventions Rationale
Provide information about additional
or outside learning sources
Reinforce and teach health practices
Made a planner for health condition

Instruct in safety measures and good
environment
Introduce and promote established
Use of multiple formats increases
learning and retention of material
To maximize self preparedness
To be able to decide if the client can
do activities in the specific situation
For good places he stays he could do
things freely
To provide concerns about the body
goals for increasing physical activity
and self care.
and health

Expected Outcome
SHORT TERM: The client shall verbalize understanding of information gained.
LONG TERM: The client shall use information to develop individual plan to meet healthcare
needs and goals.
REFLECTION:
There is not much of a problem encountered during the assessment of the client. He cooperates
well and answers the questions given honestly. Problems are that of his own medical conditions of
having Diabetes and asthma. Though he can prevent and knows the proper ways to treat them, it isnt
enough since he would still return to doing things that will trigger or worsen his condition. Most helaht
teachings are reinforced since he already named what he lacks and what he should do in terms of
managing his health. The client in knowledgeable enough and stated that hes a living a good life and
was very satisfied. Knowing that hes already an elderly client of 82 years, I found my grandfather very
inspiring for working very hard and keeping his best to be off burden to the family showing he could still
help and be part of our happiness.
As a student nurse, or even just a normal grandchild, I gained a lot of learning experiences just
through this short assessment with my grandfather. I chose him since I already know his background and
this really helps for further more knowing what an old client like him goes with his lifestyle. Watching
him do his daily activities gives me more time to evaluate all the things he can do in response to his
interview. Knowing more things about an older client will give more hints on what should be done, and
nursing interventions should be planned, in terms of their health management, sleeping, eating, coping,
elimination patterns and everything that goes under the sun is very important for taking care of them.
As a student nurse, we should value these things and promote better ways in doing our roles.