Geriatric Patient Assessment

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Geriatric Patient Assessment

Clinical Experience Reflection – Geriatric Care

This week’s clinical rotation offered a valuable opportunity to provide primary care to older adults, a population that often presents with complex, overlapping chronic conditions. As a student nurse practitioner, I focused on conducting thorough assessments and implementing age-appropriate interventions grounded in current guidelines. One particularly insightful encounter involved a 78-year-old male patient presenting for evaluation of increasing fatigue and shortness of breath.

Clinical Encounter and Challenges

One challenge I faced was navigating the subtle presentation of symptoms in older adults. Unlike younger patients, geriatric individuals may present with atypical signs, which can complicate diagnosis. This patient, for example, did not report chest pain or palpitations but instead described general “slowing down” and “difficulty catching his breath” during mild exertion. A success during this visit was my ability to establish rapport through patient-centered communication, which allowed him to feel comfortable sharing his concerns.

Assessment and Patient Presentation

Subjective Findings:
The patient complained of progressive fatigue over the last three weeks and mild dyspnea on exertion. He denied chest pain, orthopnea, paroxysmal nocturnal dyspnea, or recent illness. He also noted swelling in both ankles but attributed it to “getting older.”

Objective Findings:

• BP: 142/84 mmHg

• HR: 92 bpm, regular

• RR: 20/min

• O2 Sat: 96% on room air

• Weight: Increased by 5 lbs. over the past month

• Bilateral pitting edema (1+) in the ankles

• Clear lungs, but S3 gallop noted on cardiac auscultation

Plan of Care

Assessment:

• Likely early heart failure exacerbation, requiring further workup

• Possible comorbid anemia or hypothyroidism contributing to fatigue

Diagnostics Ordered:

• BNP (B-type natriuretic peptide)

• Echocardiogram

• CBC, CMP

• TSH levels

• ECG

Interventions:

• Low-sodium diet education

• Initiated furosemide 20 mg orally daily

• Encouraged daily weight monitoring

• Referral to cardiology for echocardiogram and further management

Follow-Up:
Scheduled follow-up in one week to review lab results and reassess symptoms.

Differential Diagnoses

1. Congestive Heart Failure (CHF)

   • Rationale: The patient’s edema, fatigue, weight gain, and presence of S3 support early-stage CHF, particularly in the absence of pulmonary symptoms or overt dyspnea at rest (Yancy et al., 2017).

2. Anemia

   • Rationale: Common in older adults, anemia can present with fatigue and exertional dyspnea. This diagnosis must be considered given the patient’s age and nonspecific complaints (Rennke & Denker, 2019).

3. Hypothyroidism

   • Rationale: Fatigue, slowed metabolism, and mild edema are classic symptoms. Subclinical hypothyroidism is prevalent in geriatric populations and can mimic cardiac symptoms (Garber et al., 2012).

Geriatric Patient Assessment

Health Promotion Intervention

Given the patient’s signs of early heart failure and cardiovascular risk factors, I focused on dietary education, including limiting sodium intake to <2,300 mg/day, increasing water intake only as advised, and encouraging physical activity within tolerance. We also reviewed medication adherence and self-monitoring practices (such as keeping a daily weight log) to detect early decompensation.

Lessons Learned

This week reinforced the importance of not overlooking seemingly vague or mild symptoms in elderly patients. It taught me to look deeper into subjective reports and integrate functional status into diagnostic reasoning. I also realized how essential patient education is in geriatric care, as many patients are unfamiliar with self-monitoring and early symptom detection. As an advanced practice nurse, developing these communication and assessment skills will be essential for delivering safe, evidence-based care.

Conclusion

Caring for geriatric patients requires a balance of clinical vigilance, empathy, and patient-centered communication. This experience helped sharpen my diagnostic reasoning and deepened my understanding of age-related presentations of common diseases. It also emphasized the value of health promotion and proactive care planning in reducing hospitalizations and improving quality of life for older adults.

References

Garber, J. R., Cobin, R. H., Gharib, H., Hennessey, J. V., Klein, I., Mechanick, J. I., … & Woeber, K. A. (2012). Clinical practice guidelines for hypothyroidism in adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocrine Practice, 18(6), 988–1028. https://doi.org/10.4158/EP12280.GL

Rennke, S., & Denker, B. M. (2019). Renal pathophysiology: The essentials (5th ed.). Wolters Kluwer Health.

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey Jr, D. E., Colvin, M. M., … & Westlake, C. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. Circulation, 136(6), e137–e161. https://doi.org/10.1161/CIR.0000000000000509