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    Geriatric Nursing Assessment Form 2

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    2BGrp3Plaza, Anna Mae
    This document contains a geriatric patient profile and nursing assessment form from Cor Jesu College in the Philippines. The profile collects basic information about a patient such as name, age, address. The nursing assessment form is a template for ongoing evaluation of a geriatric patient's mental status, sensory abilities, motor skills, vital signs, nutrition, eliminations, reproductive health, skin, comfort, and emotions over multiple days. Nurses would use this form to systematically assess the patient's condition and identify any nursing diagnoses.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Geriatric Nursing Assessment Form 2

    Uploaded by

    2BGrp3Plaza, Anna Mae
    26 views7 pages
    This document contains a geriatric patient profile and nursing assessment form from Cor Jesu College in the Philippines. The profile collects basic information about a patient such as name, age, address. The nursing assessment form is a template for ongoing evaluation of a geriatric patient's mental status, sensory abilities, motor skills, vital signs, nutrition, eliminations, reproductive health, skin, comfort, and emotions over multiple days. Nurses would use this form to systematically assess the patient's condition and identify any nursing diagnoses.

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    GERIATRIC-NURSING-ASSESSMENT-FORM-2

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    This document contains a geriatric patient profile and nursing assessment form from Cor Jesu College in the Philippines. The profile collects basic information about a patient such as name, age, address. The nursing assessment form is a template for ongoing evaluation of a geriatric patient's mental status, sensory abilities, motor skills, vital signs, nutrition, eliminations, reproductive health, skin, comfort, and emotions over multiple days. Nurses would use this form to systematically assess the patient's condition and identify any nursing diagnoses.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    26 views7 pages

    Geriatric Nursing Assessment Form 2

    Uploaded by

    2BGrp3Plaza, Anna Mae
    This document contains a geriatric patient profile and nursing assessment form from Cor Jesu College in the Philippines. The profile collects basic information about a patient such as name, age, address. The nursing assessment form is a template for ongoing evaluation of a geriatric patient's mental status, sensory abilities, motor skills, vital signs, nutrition, eliminations, reproductive health, skin, comfort, and emotions over multiple days. Nurses would use this form to systematically assess the patient's condition and identify any nursing diagnoses.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 7

    COR JESU COLLEGE, INC.

    COLLEGE OF HEALTH SCIENCES


    Tres De Mayo Campus, Brgy. Tres De Mayo, Digos City, Province of
    Davao Del Sur
    Website: www.cjc.edu.ph

    GERIATRIC PATIENT PROFILE


    Name:
    _______________________________________
    Age:
    _______________________________________
    Date of Birth:
    _______________________________________
    Sex:
    _______________________________________
    Occupation:
    3R PHOTO
    _______________________________________
    Address:
    _______________________________________
    Civil Status:
    _______________________________________
    Number of Children:
    _______________________________________
    Spouse Name: _______________________________________ Please provide documentary evidence (photos during interview, with
    Occupation: date stamp on the photo, photo with the interviewer and interviewee.
    _______________________________________ May also provide video evidence of interview.
    Mother’s Name:
    Page 1 of 7
    COR JESU COLLEGE, INC.
    COLLEGE OF HEALTH SCIENCES
    Tres De Mayo Campus, Brgy. Tres De Mayo, Digos City, Province of
    Davao Del Sur
    Website: www.cjc.edu.ph

    GERIATRIC NURSING ASSESSMENT


    ONGOING ASSESSMENT
    GUIDELINES PATIENT DAY 1 DAY 2 DAY 3
    I. MENTAL STATUS
    A. STATE OF MENTAL
    CONCIOUSNESS
    B. ORIENTATION
    C. INTELLECTUAL CAPACITY
    D. VOCABULARY LEVEL
    E. ATTENTION SPAN
    F. ABILITY TO UNDERSTAND

    II. STATUS OF SPATIAL SENSES


    A. AUDITORY PROBLEM
    B. VISUAL PROBLEM
    C. SPEECH PERCEPTION
    D. TACTILE PERCEPTION
    E. OLFACTORY PERCEPTION
    Submitted By: Submitted to:

    Page 2 of 7
    _______________________________________________________
    ______________________________________________________

    COR JESU COLLEGE, INC.


    COLLEGE OF HEALTH SCIENCES
    Tres De Mayo Campus, Brgy. Tres De Mayo, Digos City, Province of
    Davao Del Sur
    Website: www.cjc.edu.ph

    GERIATRIC NURSING ASSESSMENT


    ONGOING ASSESSMENT
    GUIDELINES PATIENT DAY 1 DAY 2 DAY 3
    III. MOTOR ABILITY
    A. CURRENT MOBILITY
    B. POSTURE
    C. RANGE OF JOINT MOTION
    D. MUSCLE AND NERVE STATUS
    E. LOSS OF EXTREMITIES

    Submitted By: Submitted to:

    _______________________________________________________
    ______________________________________________________

    Page 3 of 7
    COR JESU COLLEGE, INC.
    COLLEGE OF HEALTH SCIENCES
    Tres De Mayo Campus, Brgy. Tres De Mayo, Digos City, Province of
    Davao Del Sur
    Website: www.cjc.edu.ph

    GERIATRIC NURSING ASSESSMENT


    ONGOING ASSESSMENT
    GUIDELINES PATIENT DAY 1 DAY 2 DAY 3
    IV. BODY TEMPERATURE
    A. RANGES

    V. RESPIRATORY STATUS
    A. CHARACTER
    B. USE OF RESPIRATORY AIDS
    C. INTERFACES WITH
    RESPIRATIONS
    D. ABNORMAL RESPIRATORY
    OPENING
    VI. CIRCULATORY STATUS
    A. CHARACTERISTIC OF ARTERIAL
    PULSE
    B. BLOOD PRESSURE
    C. APICAL-RADIAL PULSE
    D. INTRAVENOUS FLUIDS

    Page 4 of 7
    Submitted By: Submitted to:

    _______________________________________________________
    ______________________________________________________

    COR JESU COLLEGE, INC.


    COLLEGE OF HEALTH SCIENCES
    Tres De Mayo Campus, Brgy. Tres De Mayo, Digos City, Province of
    Davao Del Sur
    Website: www.cjc.edu.ph

    GERIATRIC NURSING ASSESSMENT


    ONGOING ASSESSMENT
    GUIDELINES PATIENT DAY 1 DAY 2 DAY 3
    VII. NUTRITIONAL STATUS
    A. CONDITION OF BUCCAL
    ACTIVITY
    B. DIGESTION FOODS

    VIII. ELIMINATIONS STATUS


    A. BOWEL
    B. BLADDER
    C. ABNORMALITIES

    IX. MALE REPRODUCTIVE STATUS


    A. PROSTATE GLAND

    X. FEMALE REPRODUCTIVE STATUS


    A. AGE OF MENARCHE
    B. PREGNANCY
    C. VAGINA

    Page 5 of 7
    D. CERVIX
    E. VAGINAL DISCHARGE
    F. VAGINAL BLEEDING
    G. LAST MENSTRUAL PERIOD (LMP)

    COR JESU COLLEGE, INC.


    COLLEGE OF HEALTH SCIENCES
    Tres De Mayo Campus, Brgy. Tres De Mayo, Digos City, Province of
    Davao Del Sur
    Website: www.cjc.edu.ph

    GERIATRIC NURSING ASSESSMENT


    ONGOING ASSESSMENT
    GUIDELINES PATIENT DAY 1 DAY 2 DAY 3
    XII. STATE OF SKIN AND APPENDAGES
    A. SKIN
    B. HAIR
    C. NAILS

    XIII. STATE OF PHYSICAL ARREST AND COMFORT


    A. SLEEP/REST PATTERN
    B. PRESENCE OF
    PAIN/DISCOMFORT
    C. USE OF SUPPORTIVE AIDS

    XIV. EMOTIONAL STATUS


    A. EMOTIONAL REACTIONS
    B. BODY IMAGE
    C. ABILITY TO RELATE OTHERS

    XIV. NURSING DIAGNOSES


    Page 6 of 7
    Submitted By: Submitted to:
    _______________________________________________________
    ______________________________________________________

    GERIATRIC INITIAL ASSESSMENT


    CENTRAL NERVOUS SYSTEM GASTRO-INTESTINAL SYSTEM
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    ________________ ________________

    RESPIRATORY SYSTEM GENITO-URINARY SYSTEM


    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    ________________ ________________

    MUSCULO-SKELETAL SYSTEM CIRCULATORY SYSTEM


    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    ________________ ________________

    REPRODUCTIVE SYSTEM Page 7 of 7 INTEGUMENTARY SYSTEM


    _______________________________________ _______________________________________
    _______________________________________ OTHER SIGNIFICANT DATA OBTAINED _______________________________________
    _______________________________________ ___________________________________________________________________ _______________________________________
    _______________________________________ ___________________________________________________________________ _______________________________________

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