Assessment helps care planning professionals in examining their client’s life in much detail so that correct diagnosis, suitable treatment post, problem lists, and treatment goals can be developed (Health in All Policies, 2010). Generally, a clinical assessment identifies client or patient’s recent experiences and their physical, psychological, and socio-cultural history to settle on exact treatment needs (Smith & Capon, 2011). Assessment can be done in different ways but the most two types of assessment used on the basis of underlying differences are as follows:
Comprehensive assessment is a type of clinical assessment that enables the health professional or treatment provider with the determination of client’s most suitable treatment placement and treatment plan. Comprehensive assessment could be defined as a multidisciplinary investigative and treatment procedure that distinguishes medical, psychosocial, and functional restrictions of an unhealthy person with an aim to formulate a corresponding plan to maximize on the whole health with aging. Usually comprehensive assessment is used for the health care of an older adult as it is far more than the traditional medical management of illness. Providing care to old people need evaluation of number of issues such as physical, affective, social, cognitive, financial, environmental, and spiritual aspects that could be identified effectively with comprehensive assessment (Mazza & Harris, 2010).
Comprehensive assessment relies on the premise that a methodical evaluation of older individuals by a team of health professionals helps in discovering a number of treatable health issues and direct towards effective health outcomes. Comprehensive assessment is generally initiated with a referral by the primary care clinician or from some professional clinician working in hospital.
Every patient could not be referred for comprehensive assessment as there are specific evidences to identify appropriate patients for comprehensive assessment. Although there are no set criteria to refer patients for comprehensive assessment, but some specific points or criteria’ used in this concern are:
Medical comorbidities like heart failure or cancer
Psychosocial disorders like depression or isolation
Specific geriatric conditions like dementia, falls, or functional disability
Earlier or anticipated high health care utilization (Wanberg & Milkman, 2009).
Change in living situation
One outpatient approach for referring patients for comprehensive assessment is to refer patients who have problems in various areas, whereas an inpatient approach to refer would be to refer patients for CGA who are found to have problems in multiple areas during geriatric assessment screens. An inpatient approach used to refer patients for comprehensive assessment is to refer patients admitted in hospital or clinical care institute for a specific medical or surgical reason (Phillips, McKeown & Sandford, 2009).
Comprehensive assessment helps clinical care professionals in providing care with the help of six steps that are data collection, team discussion, development of a treatment plan, execution of the treatment plan, monitoring response to the determined treatment plan, and revising the treatment plan. A comprehensive assessment is undertaken with the help of qualified and trained clinicians that in turn assist the treatment provider to determine the most effective treatment placement and treatment plan (Wanberg & Milkman, 2009).
In contrast to comprehensive assessment, risk assessment refers to making decisions on the basis of acquaintance of research evidence, familiarity of the individual service user and their social background, knowledge of the service user’s own experience, and clinical judgement. In risk assessment, the clinician must collect information from two main information sources to direct clinical decisions (O’Connell, Ostaszkiewicz & Hawkins, 2011). Understanding of statistical factors in regard to the increased risk is needed, along with clinical and contextual information specific to patient’ or clinical service user’s present situation. Evidence of known risk factors can be attempted from the clinical data as well as from the patient’s demographic information (Mazza & Harris, 2010).
Demographic information like age, gender or past behaviour may be related to increased risk. Although, all these factors are static, so risk may not be decreased through the modifications in these factors. Dynamic factors on the other hand can be modified like factors related to patient’s mental state or socio-economic conditions etc (Phillips, McKeown & Sandford, 2009). Information collected from dynamic factors is more effective to inform care planning. Therefore, in risk assessment information specific to the patient and his/her contextual information need to be incorporated.
The concentration of risk assessment is to guide and support positive approaches to risk management whereas in comprehensive assessment focus is on the development of treatment placement and treatment plan. Risk assessment and its management in clinical care is a step-wise procedure that includes following steps; social and environmental context, defining the risks, distinguish who is at risk, information collection, evaluation of risks, determining which risks factors need to be modified, resource significances, communication, care planning, and review.
A continence assessment is executed by healthcare professionals with an aim to assess an individual ability to control bladder or bowel function and to agree on factors that may be imparting to incontinence. For continence management, it is vital to take continence assessment and it is undertaken in two parts: an interview and a physical assessment. As well, patient may also need to fill a bladder diary before his/her assessment (Chiarelli, 2011). A bladder diary refers to a diary of evidences and what patient was doing at the time evidences took place. A bladder diary serve health professionals with significant clues in regard to the type of incontinence an individual is facing and what are the activities that may be contributing to incontinence.
In the interview portion of the continence assessment, patient could be asked with a series of questions such as prior medical history, medication being taken, overall health, weight, smoking history, history of prostate issues (for men), pregnancy/childbirth history (for women), diabetic, problem with frequent constipation etc. In the physical assessment portion a urinalysis is done to check for kidney or bladder problems, such as infection (Ferrell & Coyle, 2010). At the same time, if needed healthcare professional (generally a nurse continence expert or a doctor) may also carry out a physical exam, together with a vaginal exam for women and a rectal exam for men. It is done to evaluate the strength of patient’s pelvic floor muscles (Phillips, McKeown & Sandford, 2009).
Physical assessment makes it easier for healthcare professionals to identify a physical problem due to which incontinence is occurring. A continence assessment is significant to identify the reason of incontinence, and recommend patients in regard to managing incontinence (Chiarelli, 2011).
A continence assessment significantly contributes in a comprehensive health assessment and this could be understood with an example of an old person comprehensive health assessment. Today, old patients have multiple problems like diabetes mellitus, chronic chest conditions etc. For dealing with all these health issues of older people, it is vital to undertake comprehensive health assessment that if also includes a continence assessment would benefit a lot to identify the actual causes of all problems in old aged patients (Miller, 2011).
Diabetes mellitus can result in number of bladder problems, including polyuria, urinary retention and urinary tract infection, so at the time of comprehensive health assessment is a continence assessment is also done it becomes easy to control the health problems and its affects at earlier stage (Chiarelli, 2011). A continence assessment assist health care professional a lot in their comprehensive health assessment as without identifying bladder functioning it is not possible to arrive at suitable treatment plan (Ferrell & Coyle, 2010).
Abnormal Findings and Actions to deal with it:
The prevalence of urinary incontinence heightens with age, so the diagnosis of it on time is essential for women. As the population of US ages, quality care professionals confront increasing number of inconsistence (Massoud, Mahshid & Behrouz, 2011). At the time of performing continence assessment one might expect these three abnormal findings:
Stress Incontinence: It refers to the spontaneous loss of urine throughout an increase of intra-abdominal pressure brought about from activities like coughing, smiling or exercising. The underlying abnormality is generally urethral hyper mobility due to the breakdown of the normal anatomic accompaniments of the urethrovesical junction. Being a planning care professional one can deal with this abnormality with the diagnosis along with various tests to assess the severity of leakage as well as undertaking specialized tests such as urodynamics and cystourethroscopy (Continence Assessment, 2010).
Detrusor instability or Detrusor hyperreflexia: These abnormalities are all due to overactive bladder. For dealing with this abnormality, a planning care professional may undertake several simple or complex urodynamic studies to arrive at the definitive diagnosis of Detrusor instability or Detrusor hyperreflexia. As well, some patients may also be treated without experiencing invasive testing. Behavioural therapy could also be used as bladder retraining and biofeedback that tries to re-establish cortical control of the bladder by appropriating the sufferer ignore exigency and void only in retort to cortical signals in waking hours (Ferrell & Coyle, 2010).
Ectopic ureters and diverticulae: Another abnormality that is expected to come up at the tiem of performing continence assessment is ectopic ureters and diverticulae. For dealing with this type of abnormality, a completed history is obtained and a physical examination is performed to initiate treatment. Treatment of women with urinary incontinence secondary to a urinary or gynecologic deformity or lack of continuity usually calls for surgery by an urogynecologist or an urologist (Continence Assessment, 2010).
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