Comprehensive Health Assessment on an Elderly Client

Introduction

According to World Health Organization (WHO), health means ‘‘A completion state on physical, mental and social wellbeing and not merely the absence of disease or infirmity’ (WHO, 1948). Comprehensive health assessment can know how a person obtained the changes from different situation like new environment, stress level and internal body systems. There are six components that conducting in a comprehensive health assessment.

Starting with physical health, a simple assessment can know the acute or underlying problem of the body. Also, developmental assessment can know if the person achieves the developmental milestone or not. Next, nutritional assessment can know the nutritional state of the person which directly affect the health. Then, the cultural, psychosocial and spiritual assessment are inseparable and influenced each other. The cultural believes affects the spiritual and psychosocial behaviors, like the methods of stress coping.

A 75 years old man who call David had been stroke three months ago. An interview and physical examination had been done by a nurse and she would discuss the psychosocial and nutritional aspects that David had been affected as below.

After observation and simple conversion with David, the nurse knew David is a traditional Chinese man who care about his self-image. He was conscious but now he had right-side hemiplegia and slurred speech. He needed a quadripod when walking and the others were difficult to communicate with him.

Firstly, the psychosocial aspect. With references to ‘‘Psychosocial Assessment in Mental Health’’, both the internal and external factors would affect the psychosocial health which related to physical health. David’s physical health was not being very well now was one the internal factors might affect his psychosocial health. He needed helps for all his daily life even take care of himself. It leaded he thought he was a burden of his family. This was the reason to move into the nursing home residents.

His self-concept was another internal factor affected his psychosocial health. The mind-body-spirit were linked-up, he had a low self-esteem and low self-acceptance of his body, David might want to harm himself due to the negative thinking.

Besides, external factors were also affected David’s psychosocial health. He was moved to nursing home. The changing of environment would let him feel stressful, he needed to adapt to the new living place and the new neighbors. David said that he was not happy with the other nursing home residents. He might feel more stressful when adapting the new environment.

Now, he needed the walking aids for walking around. It was not very convenient for him to move around. This was the reason why he seldom joined the group activities with the other residents. He could not build up a close relationship with his residents so he could not get the emotional support or a close bonding. He became more pessimistic.

David moved out from home, he also loss the primitive social bonding and the emotional support with his family members. He did not have any emotional support or hope resources when he was in trouble or unhappy. The stress affected his appetite and lead to weight loss. Directly affected both psychosocial and physical health.

Although David moved into the nursing home might weaken the relationship between his family members and him, his family members visited David regularly. He told us his family members were keen on reading the Bible and singing hymns to him and it made him felt happy and relax at that time. David could get both the emotional and social support while visited by family members. His family members could build up a positive influence on psychosocial health.

Hospital Stress Rating Scales has used to assess David’s stress level. The nursing home’s setting was similar with the hospital setting. Also, the scales assessed in different aspect, like the emotional and social. According to Measuring Patient Stress With The Hospital: STRESS: RATING SCALE (Meissner, E., Judith,1980), ‘‘This assessment tool lets you focus on one patient’s specific stressors.’’ The scales could let the nurse knew David’s specific stressors and help him to overcome it.

Secondly, the nutritional assessment. According to the interview, David looked very weak, thin and tired. He had swallowing problem after attacked by stroke three months ago, he could only tolerate the puree diet now. He was not got used to have the puree diet since the food texture had changed a lot. From solid form to puree form that made him loss his appetite. He needed to use more time to finish meal than before. He needed to add the thickener up powder to the water too. Swallowing problem was directly affected the nutritional intake and absorption to the body. It contributed David’s weight losing in these two months. Also, he was not used to have the puree diet since the food texture had changed a lot. From solid form to puree form that made him loss his appetite. From the nutritional history provided by David, he told the nurse that he was followed the food pyramid to have his daily diet before he stroked. The nurse had also used skin fold thickness and the method of body mass index to measure David’s body condition. The result shew that David was too thin, he had the problem of nutritional imbalance. Besides, David is a traditional Chinese man, he did not get use to feeding by the health care worker in the nursing home.

David complained about abdominal distention and changed in bowel habit. The feeling of abdominal distention maybe related to constipation. He said he had changed the bowel habit. He had the bowel open on every three days with hard stools. Reducing in diet intake and fluid intake affected both the nutritional and fluid absorption. It was another reason why he got weight loss in these two months.

To know the reason why David complained the abdominal distention, changed in bowel habit and a lot of blood-strained with the hard stool, the nurse had performed abdominal assessment.

Firstly, the nurse inspected David’s abdominal contour. His abdominal looked flat, symmetry and no scar on the abdominal wall. Then, she used a stethoscope to auscultate the pitch and the sounds of bowel movement. She heard the high-pitched sound and the duration around 20 seconds of each bowel movement. Percussion was the next. She heard the tympanic sound after percussion done. Refer to the book ‘‘Interpreting Signs and Symptoms’’, (Lippincott Williams & Wilkins, 2007), the result of auscultation and percussion were relevant to constipation. And last, the nurse first used the light palpation, drew a clock from the right upper quadrant to the left lower quadrant. David’s abdomen was soft, no tenderness, rigidity and guarding noted. No mass had been palpated. Then, she used the deep palpation. When the nurse palpated to the left lower quadrant, she felt a mass. Also, David scream and said pain. According to ‘‘Interpreting Signs and Symptoms’’, (Lippincott Williams & Wilkins, 2007), David’s assessment result was highly recommended that David suffered from colon cancer. The assessment could explain that why David had the problem of loss weight, loss of appetite, changed in bowel habit and a lot of blood-strained mucus when poo.

Conclusion

To sum up, the six components of health are indispensable. All the components are work closely to maintain a health human being. If one of any components are not satisfy, it will affect human to achieve the developmental task of different stage. Let’s takes David as an example, he had stroke attacked before. To compare with three months ago, his daily life had changed a lot. He needed to take care by the others therefore he moved into the nursing home. He could not adapt the changes of him now. Also, he did not get enough support for him. It is why David could not overcome his problem on both psychosocial and nutritional aspects and lead to the physical illness to him now.

The nurse is suggested to provide spiritual support to David for example reading the Bible and singing the hymns to him. It can help to give spiritual support to him which can help David to develop a healthier and positive concept on psychosocial aspect. It may help to develop a healthier physical health to David.

References

1. Lippincott Williams & Wilkins. Interpreting signs and symptoms. United States, America: Wolters Kluwer, 2007.
2. https://books.google.com.hk/books?id=PcARTQwHLpIC&dq=percussion+constipation&hl=zh-TW&source=gbs_navlinks_s
3. Meissner, E., Judith. Measuring Patient Stress With The Hospital: STRESS: RATING SCALE. Pennsylvania, Newtown: Bucks County Community College, 1980.
4. https://web-b-ebscohost-com.ezproxy.lib.ouhk.edu.hk/ehost/pdfviewer/pdfviewer?vid=0&sid=30d78691-4d14-4466-8230-5a3bf152e855%40pdc-v-sessmgr02
5. Nicola Moone & Steve Trenoweth. Psychosocial assessment in mental health. Bournemouth, England: SAGE Publications Ltd, 2017.
6. https://books.google.com.hk/books?id=S2YCDgAAQBAJ&pg=PT57&dq=psychosocial+assessment+internal+and+external&hl=zh-TW&sa=X&ved=2ahUKEwi2lIHarNTtAhWjL6YKHSpWD0IQ6AEwAHoECAIQAg#v=onepage&q=psychosocial%20assessment%20internal%20and%20external&f=false
7. World Health Organization (WHO), WHO remains firmly committed to the principles set out in the preamble to the Constitution. 2020
8. https://www.who.int/about/who-we-are/constitution