Question 1.
After completing an A-G assessment in an acute care unit you suspect that the older person has altered cognition- confusion.
a. Describe four (4) nursing actions that are appropriate in this clinical situation.
b. Why would you undertake these actions?
Numbe
a. Nursing Action
b. Reason why
1
2
3
4
Question 2.
Patient has had a Mini-mental Status Exam (MMSE) completed by the CNC for Dementia and Delirium and results are as following:
Maximum Score
Patient’s Score
Questions
5
1
Season co
ect
“What is the year? Season? Date? Day of the week? Month?”
5
3
Country, state and town co
ect
“Where are we now: State? County? Town/city? Hospital? Floor?”
3
2
The examiner names three unrelated objects clearly and slowly, then asks the patient to name all three of them. The patient’s response is used for scoring. The examiner repeats them until patient learns all of them, if possible. Number of trial: 3times, but only got 2 co
ect.
5
0
I would like you to count backward from 100 by sevens.” (93, 86, 79, 72, 65, …) Stop after five answers. Alternative: “Spell WORLD backwards.” (D-L-R-O-W)
3
1
Earlier I told you the names of three things. Can you tell me what those were?”
2
2
Show the patient two simple objects, such as a wristwatch and a pencil, and ask the patient to name them.
1
0
Repeat the phrase: ‘No ifs, ands, or buts.’”
3
0
Take the paper in your right hand, fold it in half, and put it on the floor.” (The examiner gives the patient a piece of blank paper.)
1
0
Please read this and do what it says.” (Written instruction is “Close your eyes.”)
1
0
Make up and write a sentence about anything.” (This sentence must contain a noun and a ve
.)
1
0
Please copy this picture.” (The examiner gives the patient a blank piece of paper and asks him/her to draw the symbol below. All 10 angles must be present and two must intersect.)
30
9
Total
Interpretation of MMSE
Method
Score
Interpretation
Single cut-off
<24
Abnormal
Range
<21
25
Increased odds of dementia
Decreased odds of dementia
Education
21
23
24
Abnormal for 8th grade education
Abnormal for high school education
Abnormal for college education
severity
24-30
18-23
0-17
No cognition impairment
Mild cognition impairment
Severe cognition impairment
a. Describe four (4) pieces of information from the completed Mini-mental Status Exam (MMSE) of patient. This description should include a description of the information contained in the MMSE and the meaning of the score which relates to the information regarding cognition.
b. For each of these pieces of information discuss how a nurse would adjust the way they communicate with this older person.
Numbe
a. Description and meaning of each piece of information from completed MMSE
b. Communication strategies that are linked to each piece of described MMSE information
1
2
3
4
Question 3.
Discuss the reasons why is it necessary to conduct a holistic, comprehensive assessment on older people when working with them?
Question 4.
You are a nurse working in general practice. an 80-year-old woman who is new to your practice. After doing an initial health screen you note a few health issues. For each of the identified health issues:
a. Discuss why this information is concerning?
b. Based on the health issue identified what focused assessment should be next completed to comprehensively understand her health issues.
Health issue
a. Why this information is concerning
b. What focused assessment should be completed
1. BMI of 22
2. A fall recently
3. Feeling anxious and wo
ying.
4. Does not like to drink water and prefers to drink hot tea
5. Experiences pain daily
6. Episodes of constipation
Reference List