From the Guidelines
When conducting an assessment on an adult, particularly an older adult, healthcare providers should apply the "Geriatric 5Ms" framework, which consists of evaluating the mind, mobility, medications, what matters most to the patient, and multicomplexity, to manage the patient's care effectively. This approach is crucial in older adults due to the high prevalence of geriatric syndromes such as frailty, delirium, and falls, which can negatively affect functional status, quality of life, and mortality 1.
The assessment should begin with evaluating the mind, considering the cognitive and psychological domains of the patient's health, and using appropriate screening tools to assess mental status and cognitive function. Next, mobility and fall risk should be evaluated to identify potential safety concerns and develop strategies to prevent falls 1.
A thorough review and reconciliation of medications, particularly high-risk medications, is also essential to minimize adverse effects and optimize medication management. Healthcare providers should ask what matters most to the patient to understand their values, preferences, and goals, and incorporate this information into the care plan. Finally, assessing multicomplexity, or how the intersection of multiple chronic conditions and social determinants of health influence the patient's health care management, is critical to developing a comprehensive and coordinated care plan 1.
Key components of the assessment include:
- Evaluating cognitive and psychological domains
- Assessing mobility and fall risk
- Reviewing and reconciling medications
- Understanding what matters most to the patient
- Assessing multicomplexity and its impact on health care management By applying the Geriatric 5Ms framework, healthcare providers can ensure that older adults receive comprehensive, patient-centered care that addresses their unique needs and promotes optimal health outcomes, reducing disability, hospitalization, and institutionalization, and improving quality of life 1.
From the Research
Assessment Framework
The process of conducting a physical assessment on an adult involves several steps, including:
- Identifying the purpose of the assessment 2
- Taking a health history 2
- Choosing a comprehensive or focused approach 2
- Examining the patient using the sequence of inspection, palpation, percussion, and auscultation 2
- Interpreting the clinical findings, which results in either the recognition of abnormality or identification of a differential diagnosis 2
Comprehensive Assessment
A comprehensive, head-to-toe assessment is one example of the application of this physical assessment framework in clinical practice 2. This approach is essential in ensuring that all aspects of the patient's health are evaluated.
Accurate and Comprehensive Assessment
Accurate assessment of the acutely ill adult is crucial in ensuring that management strategies are implemented in a timely manner 3. The National Early Warning Score (NEWS) is a useful tool in identifying patients who are at risk of deterioration 3. The ABCDE (airway, breathing, circulation, disability, and exposure) approach to assessment is also an essential framework in evaluating the patient's condition 3.
Patient Assessment Skills
Nurses require specific patient assessment skills to identify signs of patient deterioration, regardless of cause 3. These skills include the ability to evaluate the patient's airway, breathing, circulation, disability, and exposure.
Laboratory Tests
Laboratory tests, such as complete blood count (CBC), can be useful in assessing cardiovascular and metabolic diseases in clinical settings 4. The CBC components, including white blood cell count, neutrophil-to-lymphocyte ratio, hemoglobin, mean corpuscular volume, red cell distribution width, platelet count, mean platelet volume, and platelet-to-lymphocyte ratio, can predict the risk of cancer, cardiovascular disease, arteriosclerosis, type 2 diabetes, and metabolic syndrome 4.