Assessment of Older Adult

By Ainsley & Ashley

Cardiovascular disease
(congestive heart failure )
• Cardiovascular disease: A disease
process in which affect the structure or
function of the heart.
• Our patient is diagnosed with
Congestive Heart Failure which is a
 chronic and progressive condition that
affects the pumping power of
your heart muscle.
• This diagnosis affects our patient is all
aspects of his life including physically,
mentally, socially and emotionally.
Description on the client we
will be assessing
Bruce. W who is a 58-year-
old man, who is married with
a single income. He has 3
kids and is very hard working
as a city Bus driver. He was
recently diagnosed with
Congestive Heart Failure and
is on a diuretic for his CHF.
Bruce owns a two-story
home with stairs. His diet
isn't proper, as he often gets
takeout after his shifts, and
he isn’t as active as he
should be with his current
job. His sleeping habits are
also reversed due to his
overnight bus route. 
 4 priority problem health
patterns from Gordon’s
Framework
• Nutrition: Dietary measures are a n issue with our
client as he is a city bus driver and often eats
unhealthy and very salty high cholesterol foods,
causing issues in people diagnosed with HF.
Sodium restriction is recommended to decrease
any fluid retention associated with HF. However,
with our patient intaking a ton of salty food his
fluid retention will be increased.
• Another priority problem related is the issue of
malnutrition. Several factors contribute to
malnutrition in HF, altered mental status, dyspnea,
and fatigue interfere with the ability to eat. As well
as anorexia and GI upset occurs from exerted
pressure from excess fluid surrounding the GI
structures. ( Williams, hopper p.528-529)
 4 priority problem health
patterns from Gordon’s
Framework
• Sleep/rest: (also elimination): laying down
to sleep the fluid in the lower legs returns to
circulatory system renal blood flow and
filtration is increased resulting in greater
urine production and the need to urinate
frequently during their sleeping hours.
• Activity : is a priority problem for our client
because of his diagnosis of HF he is even
more fatigued and weak from a decreased
amount of oxygen reaching the tissues
during the day and fatigue worsens with
activity therefore, activity is a problem for
our patient causing him to be unactive
leading to a range of other health related
issues.
• (Williams, Hopper p. 525-527)
 Determinants of
Health
• Nutrition; Income and Income Distribution: is matched with nutrition as his income
influences his eating habits and choices.
• Food Insecurity: due to his single income and a family to feed nutrition isn’t always
attainable and not cost effective to feed a larger family very nutritious and healthy foods.

Elimination: Housing is matched with elimination due to his housing being a two-story
house and the bathroom is upstairs and is a challenge at times for him to reach due to him
being on a diuretic he frequents the bathroom often and it is challenging with the CHF to
be going up and down the stairs so often.
income and income distribution is matched with elimination due to his single income and
needing equipment better suited to his needs, this being a downstairs bathroom to be
better attainable for him to reach
Employment and Working Conditions is matched with elimination as he is a bus driver and
is on a diuretic meaning he frequents the washroom often which is often hard to find a
washroom working as a bus driver.
 Determinants of
Health
• Sleep and rest : is matched with Employment and Working Conditions
due to his sleep patterns being reversed due to his job being a bus
driver, he drives the night shifts causing sleep and rest to be often
disturbed and him not being well rested.
• Social exclusion/ health services : working the night shift makes it hard
for him to see his family, friends and to make his doctor appointments.
Leaving him socially excluded from most social events due to him
sleeping during those hours.
• sleep and rest is matched with education due to him being on diuretics
and being educated on taking the diuretics in the AM when is is going to
sleep causing frequent bathroom trips during his rest hours.

• Activity: is matched with Employment and Working Conditions due to

him being a night-time bus driver and is often unable to exercise leaving
him physically unfit and has possibly lead to the cardiovascular
disorders.
 Health Promotion strategies
• 1. Teach about the use of assistive devices and lifestyle changes Rationale:
assistive devices can overcome limitations to increase activity
• 2. Decrease sodium intake as ordered Rationale: sodium retains fluid.
• 3. Identify barriers to sleep Rationale: anxiety, nocturia, diuretics, orthopnea can
make sleep difficult
• 4.Monitoring daily intake and output as well as daily weights Rationale: intake
and output will show any imbalances and daily weights will indicate any fluid
retention
• 5. Provide rest, space out activities to conserve energy. Rationale: myocardial
oxygen need is decreased in HF.
• (Williams, Hopper p. 535)
4 health promotion
programs in community

• . 1. Institute of Culinary Education

offers free cooking classes online
so it is attainable to a great range
of people, they offer classes for
nutritious meals which could help
Bruce and his family attain
healthier eating habits.
• 2. Introduce Bruce to Canadian
Red-Cross to help with any
equipment he may need instead
of renovating (which can be
costly) he can use red cross as
needed for elimination equipment
as it is very cost efficient or free.
4 health promotion programs
in community
• 3. Nanaimo recreational offers activity services all ages
swimming,  fitness, and music etc. Which would help Bruce be
active and be healthy and fit because of this heart condition.
Family swim if he wants to make it a family outing. 

• 4. Finding Support for hearty health!...Healthline I found this

link not only directed for heart attack but heart disease and
more. A support group to have others who understand what
you are going through with heart disease. It helps to talk to
someone in the same situation. 
 Reflection
Working on this assignment really helped us to understand how

every single individual is so different and that you must cater your care

to their needs. Although we did already have an idea about this we

learnt that your care and how you plan for care will be so different for

each and every person. As for how this assignment will guide my

practice as a future PN Leader, we both plan to guide our leadership

roles to teach and educate on the importance of planning for each and

every patient differently to directly effect and cater to their culture,

their families their lifestyle and plan holistically for their care.
 References
• American heart association. (2021). What is cardiovascular disease.
Retrieved from:
https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardi
ovascular-disease

• Institute of culinary education. (2020).Free online cooking classes.

Retrieved from:https://www.ice.edu/newyork/free-online-cooking-classes

• Canadian Red cross. (n.d.).Programs and services. Retrieved from:

https://www.redcross.ca/in-your-community/british-columbia-and-yukon

• L. Williams., P. Hopper. (Jan. 25 2019) ) Understanding Medical Surgical

Nursing.  F.A. Davis Company.
 Refrence Cont...
https://www.nanaimo.ca/parks-recreation-culture/recreation-facilities-schedules/activity-guide

https://www.healthline.com/health/heart-disease/finding-support-after-heart-attack