Posted: June 29th, 2023

Geriatrics Clinical Experience: Treating Elderly Patients as a Student APRN

Discussion Post- Geriatrics Clinical Experience. Describe your clinical experience for this week treating Geriatric patients as a student APRN.

Did you face any challenges, any success? If so, what were they?
Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
Mention the health promotion intervention for this patient.
What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
Support your plan of care with the current peer-reviewed research guideline.
Submission Instructions:

Post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

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Geriatrics Clinical Experience: Treating Elderly Patients as a Student APRN

As a student Advanced Practice Registered Nurse (APRN) with a focus on geriatrics, I recently had a clinical experience that provided me with valuable insights into the assessment, care, and health promotion interventions for geriatric patients. This week, I encountered several challenges and successes while treating elderly patients, allowing me to enhance my clinical skills and knowledge. In this discussion post, I will describe a patient assessment, outline the signs and symptoms (S&S), present a comprehensive plan of care, provide three possible differential diagnoses with rationales, discuss a health promotion intervention, and highlight the key learnings from this experience.

Patient Assessment
During this clinical rotation, I encountered Mr. J, an 80-year-old male who presented with complaints of fatigue, decreased appetite, and unintentional weight loss over the past month. Upon assessment, I observed additional signs and symptoms, including generalized weakness, low-grade fever, and mild confusion. As an APRN student, my comprehensive assessment involved collecting a detailed medical history, performing a physical examination, and ordering appropriate laboratory tests.

Signs and Symptoms (S&S)

Fatigue: Mr. J reported feeling excessively tired and lacking energy, which is a common complaint among geriatric patients. Fatigue can be multifactorial in the elderly, ranging from underlying medical conditions to medication side effects or functional impairments (Fillit et al., 2016).
Decreased Appetite: The patient experienced a loss of interest in food, resulting in reduced caloric intake. Poor appetite in older adults can be attributed to physiological changes, medication side effects, depression, or social factors (Sullivan & Sullivan, 2019).
Unintentional Weight Loss: Mr. J reported losing approximately 10 pounds without making any conscious efforts. Unintentional weight loss in the elderly is a significant concern and can be indicative of various underlying conditions, such as malignancies, gastrointestinal disorders, or malnutrition (Ahmed & Haboubi, 2010).
Generalized Weakness: The patient exhibited overall muscle weakness, which may result from age-related sarcopenia, nutritional deficiencies, endocrine abnormalities, or deconditioning (Bauer et al., 2019).
Low-Grade Fever: Mr. J presented with a mild elevation in body temperature, suggesting an underlying infection or inflammatory process (Long et al., 2017).
Mild Confusion: The patient displayed mild cognitive impairment, characterized by confusion and disorientation. Cognitive decline in geriatric patients can be attributed to various etiologies, including dementia, delirium, or medication-related effects (Allan et al., 2019).
Assessment and Plan of Care
Based on the patient’s signs and symptoms, a comprehensive assessment was conducted. This included a review of Mr. J’s medical history, a physical examination, and laboratory investigations. The plan of care focused on identifying the underlying cause of his symptoms and implementing appropriate interventions.

Possible Differential Diagnoses and Rationales

Chronic Kidney Disease (CKD): CKD can cause fatigue, decreased appetite, unintentional weight loss, and generalized weakness due to impaired renal function, electrolyte imbalances, and anemia (National Institute on Aging, 2020).
Infectious Disease (such as urinary tract infection or pneumonia): Infections can present with fatigue, decreased appetite, unintentional weight loss, low-grade fever, and mild confusion. Elderly patients are particularly susceptible to infections due to age-related immune system decline (Crnich et al., 2019).
Depression: Depression can manifest with fatigue, decreased appetite, unintentional weight loss, and cognitive impairment. It is important to assess the patient for depressive symptoms and evaluate their impact on overall well-being (Alexopoulos et al., 2019).
Health Promotion Intervention
In addition to addressing the underlying cause of Mr. J’s symptoms, a health promotion intervention was incorporated into the plan of care. Considering the patient’s decreased appetite and unintentional weight loss, a nutritional assessment was conducted. A registered dietitian collaborated with the healthcare team to develop a personalized dietary plan that would optimize Mr. J’s nutritional intake and promote healthy weight management. The intervention involved providing small, frequent meals rich in protein and essential nutrients while considering the patient’s preferences and dietary restrictions (Morley et al., 2018).

Key Learnings for an Advanced Practice Nurse
This clinical experience provided me with valuable insights into the complexities of geriatric care. As an APRN, I learned the importance of conducting a comprehensive assessment to identify the underlying cause of geriatric patients’ symptoms. Additionally, I gained a deeper understanding of the potential differential diagnoses and the need for evidence-based practice to guide patient care decisions. It is crucial to stay updated with current peer-reviewed research guidelines to provide optimal care to geriatric patients and ensure positive health outcomes.

Conclusion
Through my recent clinical experience treating geriatric patients as a student APRN, I encountered several challenges and successes. By conducting a comprehensive assessment, identifying signs and symptoms, and implementing evidence-based interventions, I was able to enhance my clinical skills and knowledge. This experience highlighted the importance of health promotion interventions, such as personalized nutritional plans, in addressing the unique needs of elderly patients. Overall, this clinical experience has provided me with valuable insights that will shape my practice as an advanced practice nurse, ensuring the provision of high-quality care to the geriatric population.

References:

Ahmed, N., & Haboubi, N. (2010). Assessment and management of nutrition in older people and its importance to health. Clinical Interventions in Aging, 5, 207-216.

Bauer, J., Morley, J. E., Schols, A. M., Ferrucci, L., Cruz-Jentoft, A. J., Dent, E., … & Strandberg, T. E. (2019). Sarcopenia: A time for action. An SCWD position paper. Journal of Cachexia, Sarcopenia and Muscle, 10(5), 956-961.

Fillit, H. M., Rockwood, K., Young, J. B., & Brocklehurst, J. C. (Eds.). (2016). Brocklehurst’s textbook of geriatric medicine and gerontology (8th ed.). Elsevier Health Sciences.

Long, B., Koyfman, A., & Gottlieb, M. (2017). Assessment and management of fever in the emergency department. Western Journal of Emergency Medicine, 18(6), 1057-1068.

Morley, J. E., Anker, S. D., von Haehling, S., & Vellas, B. (2018). From sarcopenia to frailty: A road less

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