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    Geriatric Nursing Assessment Form 2

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    2BGrp3Plaza, Anna Mae
    This document contains a geriatric patient profile and assessment form from Cor Jesu College in the Philippines. The profile collects basic patient information. The assessment form evaluates the patient's mental status, sensory abilities, motor skills, vital signs, nutrition, eliminations, reproductive health, skin, comfort, and emotions over multiple days. Nurses will use this ongoing assessment to monitor the patient's health and develop appropriate 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
    40 views7 pages
    This document contains a geriatric patient profile and assessment form from Cor Jesu College in the Philippines. The profile collects basic patient information. The assessment form evaluates the patient's mental status, sensory abilities, motor skills, vital signs, nutrition, eliminations, reproductive health, skin, comfort, and emotions over multiple days. Nurses will use this ongoing assessment to monitor the patient's health and develop appropriate nursing diagnoses.

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    Original Title

    GERIATRIC-NURSING-ASSESSMENT-FORM-2

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    This document contains a geriatric patient profile and assessment form from Cor Jesu College in the Philippines. The profile collects basic patient information. The assessment form evaluates the patient's mental status, sensory abilities, motor skills, vital signs, nutrition, eliminations, reproductive health, skin, comfort, and emotions over multiple days. Nurses will use this ongoing assessment to monitor the patient's health and develop appropriate nursing diagnoses.

    Copyright:

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

    Geriatric Nursing Assessment Form 2

    Uploaded by

    2BGrp3Plaza, Anna Mae
    This document contains a geriatric patient profile and assessment form from Cor Jesu College in the Philippines. The profile collects basic patient information. The assessment form evaluates the patient's mental status, sensory abilities, motor skills, vital signs, nutrition, eliminations, reproductive health, skin, comfort, and emotions over multiple days. Nurses will use this ongoing assessment to monitor the patient's health and develop appropriate 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: _______________________________________
    Address: _______________________________________
    Civil Status: _______________________________________
    Number of Children: _______________________________________
    Spouse Name:
    _______________________________________
    Occupation:
    _______________________________________
    Mother’s Name: _______________________________________
    Occupation: _______________________________________
    Address: _______________________________________
    Father’s Name:
    _______________________________________
    Occupation: _______________________________________
    Please provide documentary evidence (photos during interview, with
    Address: _______________________________________
    date stamp on the photo, photo with the interviewer and interviewee.
    Religion: _______________________________________
    May also provide video evidence of interview.

    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:

    _______________________________________________________ ______________________________________________________

    COR JESUPage
    COLLEGE,
    2 of 7 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

    Submitted By: Submitted to:

    _______________________________________________________ ______________________________________________________

    COR JESUPage
    COLLEGE,
    4 of 7 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
    D. CERVIX
    E. VAGINAL DISCHARGE
    F. VAGINAL BLEEDING
    G. LAST MENSTRUAL PERIOD (LMP)

    COR JESU COLLEGE, INC.


    COLLEGE OF HEALTH
    Page 5 of 7 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

    Submitted By: Submitted to:


    _______________________________________________________ ______________________________________________________

    Page 6 of 7
    GERIATRIC INITIAL ASSESSMENT
    CENTRAL NERVOUS SYSTEM GASTRO-INTESTINAL SYSTEM
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    ________________ ________________

    RESPIRATORY SYSTEM GENITO-URINARY SYSTEM


    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    ________________ ________________

    MUSCULO-SKELETAL SYSTEM CIRCULATORY SYSTEM


    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    _______________________________________ _______________________________________
    ________________ ________________

    REPRODUCTIVE SYSTEM INTEGUMENTARY SYSTEM


    _______________________________________ _______________________________________
    _______________________________________ OTHER SIGNIFICANT DATA OBTAINED _______________________________________
    _______________________________________ ___________________________________________________________________ _______________________________________
    _______________________________________ ___________________________________________________________________ _______________________________________
    ________________ ___________________________________________________________________ ________________
    ___________________________________________________________________
    ________________________

    Page 7 of 7

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