Author Question: An older client in a long-term care facility is receiving an annual physical examination and is ... (Read 23 times)

evelyn o bentley · **on:** Jul 11, 2018

An older client in a long-term care facility is receiving an annual physical examination and is or-dered laboratory tests that include a complete blood count, serum electrolytes, and thyroid tests.

When the client's son questions why these tests are being ordered by saying, Dad is 85 why are you bothering him? the nurse's response is based on an understanding that:
a. the health care provider ordering the tests needs to explain the rationale to the son.
b. when conducted annually, all of the tests are helpful in promoting maximum health for older adults in the long-term care set-ting.
c. the tests are useful, but only if clinically indicated.
d. the complete blood count and serum elec-trolytes are useful screening tests, but the usefulness of the thyroid test should be questioned.

Question 2

A nurse utilizes the SPICES tool (Sleep disorders, Problems with eating, Incontinence, Confu-sion, Evidence of falls, and Skin breakdown) to assess an older female patient in the hospital.

The nurse notes that the patient has new onset urinary incontinence. The first action by the nurse is to:
a. conduct a more in-depth focused assess-ment of the urinary incontinence.
b. call the provider and obtain an order for an antibiotic for a suspected urinary tract infection.
c. send a urine specimen for culture and sen-sitivity.
d. develop a plan of care with the patient to control episodes of incontinence.

jomama · **Reply #1 on:** Jul 11, 2018

Answer to Question 1

ANS: B
Laboratory tests are a fast and accurate way of assessing key parts of an older person's physical functioning. It is within the nurse's scope of practice to answer the son's question and it does not need to be referred to the health care provider. The laboratory tests are being used as annual screening and therefore do not need to be clinically indicated. Excessive sleepiness is not normal in an 85-year-old and may be a sign of a thyroid disorder.

Answer to Question 2

ANS: A
SPICES is an assessment tool. Anything that indicates a problem in any of the categories warns the nurse that a more in-depth assessment is needed. The nurse needs to further assess the urinary incontinence prior to implementing any interventions.