Evaluation Plan
1)The patient is a 78-year old retired postal worker that presents for his yearly physical exam. He has a medical history of osteoarthritis (10 years) and GERD and complains of knee pain that worsened progressively in the past six months. The patient has also requested his annual influenza vaccination and made inquiries about any other shorts that may be needed. The results of the physical exam point to worsening osteoarthritis in the left knee.
Evaluation Plan
Coaccioli et al., (2022) determined that knee osteoarthritis is a condition that tends to worsen and become more debilitating for older adults. An assessment tool that could be used for this patient is the Western Ontario and McMaster Universities OA (WOMAC). This tool helps practitioners to determine the patient’s stiffness, pain, and knee function (Perrot et al., 2023). The WOMAC has been validated among older adult populations and demonstrated a bigger responsiveness to change compared to other subscales and tests (Perrot et al., 2023). This test is ideal because it only takes 12 minutes and can be completed on paper or online.
The evaluation should take place in a private room that guarantees the patient’s privacy. Hsu & Siwiec (2023) noted that the evaluation can be done through the collaboration of different health care professionals such as a physical therapist, nursing staff, dietitians, rheumatologist, and pain management specialist. The patient’s caregiver should also be involved in the development of the plan and the patient’s education; this is because older adult patients rely a lot on their caregivers during recovery. Examples of issues that may arise during the assessment include lack of awareness among patients about the lack of cure for osteoarthritis and medication non-compliance (Hsu & Siwiec, 2023). Some patients may also experience mood changes due to their condition and functional impairment.
The patient’s plan should be based on a comprehensive history and findings from the physical exam and diagnostic testing. Based on the findings, the writer recommends non-surgical treatment options; this is the main recommendation made by the American Academy of Orthopedic Surgeons (AAOS). These include patient education on weight loss/weight management through low impact exercises and nutritional control (Hsu & Siwiec, 2023). This patient is also an ideal candidate for physical therapy. This is usually in the form of home exercises or supervised exercises. The patient has symptomatic osteoarthritis and could benefit from medications. The recommended first line of pharmacotherapy is Nonsteroidal Anti-Inflammatory Drugs (NSAIDs); acetaminophen is commonly prescribed (Hsu & Siwiec, 2023). The immunization requirements that may be needed for this patient are the influenza shot, pneumococcal vaccine, and shingles.
References
Coaccioli, S., Sarzi-Puttini, P., Zis, P., Rinonapoli, G., & Varrassi, G. (2022). Osteoarthritis: New insight on its pathophysiology. Journal of Clinical Medicine, 11(20), 6013. https://doi.org/10.3390/jcm11206013
Hsu, H., & Siwiec, R. (2023). Knee osteoarthritis. In: StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507884/
Perrot, S., Trouvin, A. P., & Bouhassira, D. (2023). Three dimensions of pain in osteoarthritis: development and validation of the Osteoarthritis Symptom Inventory Scale. Pain, 164(7), 1566–1577. https://doi.org/10.1097/j.pain.0000000000002856
2nd reply
Evaluation Plan and Assessment Tools
The evaluation plan for this patient would be a comprehensive exam, sure to include the status of his osteoarthritis, his current functional status, and his overall health maintenance. An overall history and physical examination will be completed, focusing on his osteoarthritis and any new or worsening factors associated with his increased pain. An assessment of activities of daily living, as well as any new limitations related to his increased pain. Two assessment tools are appropriate for this patient to ensure he is appropriately assessed and treated. The first assessment tool appropriate for this patient is the Katz Index of Independence in Activities of Daily Living. This tool focuses on age-related changes and obstacles that inhibit the full functional status of an older adult (McCabe, n.d.). This assessment tool focuses on daily living activities such as bathing, dressing, toileting, transferring, continence, and feeding. The second assessment tool that would benefit this patient is the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The WOMAC assessment tool focuses on the patient\’s pain, stiffness, and physical function (da Silva Junior et al., 2023). This tool will help capture the impact arthritis has on this patient from patient-reported outcomes.
Validation and Potential Issues
The WOMAC tool and the tool assessing ADLs are validated for this patient due to these tools being self-reported by the patient himself. The potential issues with these tools include a language barrier, education and health literacy, mental states, and assistive devices. Although the tools are self-reported, there may be an issue with cognitive impairment that may hinder the patient’s learning abilities (Muijsenberg et al., 2023). In addition to cognitive impairment, the patient may be facing exhaustion, frustration, and stress due to the length of this disease as well as the increased severity of pain (Muijsenberg et al., 2023). These factors may also contribute to the outcome of the assessment tool and prevent the patient from receiving proper treatment.
Hearing and visual impairments and cultural relevance may also create obstacles to performing assessments. Assessment tools may need to be in larger print or a verbal demonstration to ensure the patient answers to the best of their ability. All assessment tools must be culturally sensitive and adaptable for each patient, individualizing their care (Muijsenberg et al., 2023). Potential issues with screening tools must be recognized before the assessment is completed. This will help with the accuracy of the assessment and allow an appropriate and focused care plan for the patient.
Immunization Requirements
As people age, their immune system declines, making them more susceptible to diseases and increasing the length of the disease present. Adults 65 years or older are recommended to receive the annual flu, pneumococcal, shingles, and COVID-19 vaccination. These vaccinations are highly recommended for patients with chronic conditions, such as osteoarthritis. If patients contract these diseases, their risk of hospitalization and complications increases (National Institute on Aging, 2023).
References
da Silva Junior, J., Dibai-Filho, A, Santos, I., Protazio, J., Junior, J., de Oliveira, D., dos Santos, P., & Fidelis-de-Paula-Gomes, C. (2023). Measurement properties of the short version of the Western Ontario and mcmaster universities arthritis index (WOMAC) for individuals with knee osteoarthritis. BMC Musculoskeletal Disorders, 24(1). https://doi.org/10.1186/s12891-023-06696-0
McCabe, D. (n.d.). Katz Index of Independence in Activities of Daily Living (ADL). Hartford Institute for Geriatric Nursing. https://hign.org/sites/default/files/2020-06/Try_This_General_Assessment_2.pdf
Muijsenberg, A., Houben-Wilke, S., Zeng, Y., Spruit, M., & Janssen, D. (2023). Methods to assess adults’ learning styles and factors affecting learning in Health Education: A scoping review. Patient Education and Counseling, 107, 107588. https://doi.org/10.1016/j.pec.2022.107588
National Institute on Aging. (2023). Vaccinations and older adults | National Institute on Aginghttps://www.nia.nih.gov/health/immunizations-and-vaccines/vaccinations-and-older-adults
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