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1. Mentation SCREENING - Mood
1.1. ANSWER KEYS
1.1.1. Answer Card: PHQ-2 performed #136
1.1.1.1. ASSOCIATED KEYWORDS: depression, mood, ask, hopeless, perform, appears, card, question, mental, status, health, sad, depressed, suicide, slow, moving, sluggish, anger, lethargic,
1.1.1.2. HINT FOR ANSWER CARD: Have you checked for mood AND memory?
1.1.2. Enables Card: No Mood Abnormalities #14
1.2. NP I would now like to ask you a few questions - we screen for mood and memory, as they are just as important as physical health issues.
1.3. 0 Provider performs the PHQ-2 to evaluate the patient's mood.
1.4. 0 Patient's results indicates no depressive symptoms
2. Discharge
2.1. P My hearing seems to be better, Thank you again for your help!
2.1.1. 0 [Patient stands up from chair]
2.2. NP You are welcome, Mr. Bell, have a great day!
2.3. P You too, good bye!
2.3.1. 0 [Patient turns and shuffles out of exam room]
3. Treatment
3.1. 0 [Provider removes cerumen from Mr. Bell's ears]
3.2. NP Okay, the ear wax is removed.
4. Physical Assessment
4.1. 0 Provider takes Mr. Bell's vital signs, which are all within normal limits
5. History of Present Illness
5.1. NP So, what brings you in today?
5.2. P I want you to check my ears. I've been having more trouble hearing my music.
5.3. NP Ok, Mr. Bell, I can check your ears and hearing.
6. Medication Reconcilliation
6.1. NP Mr. Bell, can you tell me what medications you are taking?
6.2. P I take something to lower cholesterol and also Tylenol, when my joints ache.
7. Onboarding
7.1. [Kiosk Use]
7.1.1. NP - Mr. Harley Bell?
7.2. Call Patient
7.2.1. NP Mr. Harley Bell?
7.2.2. 0 Provider notes no answer from Mr. Bell
7.2.3. NP Mr. Harley Bell?
7.2.4. P Are you calling for Harley Bell?
7.2.5. NP Yes, Mr. Bell, I am ready for you, please come in.
7.2.5.1. 0 [Patient rises and shuffles into exam room]
7.3. Registration
7.3.1. NP My name is Taylor and I will be your practitioner today.
8. Mobility SCREENING
8.1. ANSWER KEYS
8.1.1. Answer Card: Modified Get Up and Go #135
8.1.1.1. KEYWORDS: get, modified, timed, tug, test, assess, gait, notice,
8.1.1.2. HINT FOR ANSWER CARD: Which test is performed for mobility?
8.1.2. Enables Card: Shuffling #37
8.1.3. Points Awarded: 1
8.2. 0 Provider notices Mr. Bell has significant shuffling as he walks to exam room, and has a little difficulty getting in and out of the chair.
9. History of Present Illness [cont]
9.1. NP Have you noticed anything that improves your hearing?
9.2. P It helps when I come here and have the wax removed from my ears.
10. Medication SCREENING
10.1. ANSWER KEYS
10.1.1. Answer Card: Medications reviewed against Beers list #139
10.1.1.1. KEYWORDS: review, medications, Beers, document, notice, nonsteroidal, criteria, list, pamphlet, AGSBeers,
10.1.1.2. HINT FOR ANSWER CARD: Have you checked for inappropriate medications?
10.1.2. Enables Card: No Abnormalities noted in medication reconcilliation #17
10.2. 0 [Provider notes that Tylenol is NOT on the AGS Beers Criteria list]
10.3. NP How much and many times a day do you take the Tylenol?
10.4. p I take two regular Tylenol, two or three times a day, only when I have the joint pain.
10.5. NP Okay, is there anything else you are taking for pain, and what do you take for cholesterol?
10.6. P Why do you need to ask about all of my medications? Can't you see them in my chart?
10.7. NP We want to make sure the medications you are currently taking are safe for you.
10.8. NP Plus, we want to be sure the medications you are taking are not limiting your ability to do what matters to you, your mobility, or your mood and memory.
10.9. p oh, okay - I don't take anything else for pain, and I take atorvastatin at bedtime for my cholesterol.
11. Medication OBSERVATION
11.1. ANSWER KEYS
11.1.1. Answer Card: No medication abnormalities #17
11.1.1.1. KEYWORDS: ibuprofen, overdose, tablets, too, much, high, nonsteroidal, motrin, advil, aleve, naproxen, dosage. levels,
11.1.1.2. HINT FOR ANSWER CARD: Were any abnormalities noted in medication?
11.1.2. Enables Card: Education on AGS Beers Criteria and high-risk medications using the 4M brochure #121
11.2. NP It seems to me that the medications you're taking are appropriate for an older adult, and you're taking them correctly.
12. Medication ACTION
12.1. ANSWER KEYS
12.1.1. Answer Card: Education on AGS Beers Criteria and high-risk medications using the 4M brochure #121
12.1.1.1. KEYWORDS: treatment, alternative, medications, other, regimen, recommend, AGS, Beers, deprescribe, decrease, dosage, identify,
12.1.1.2. HINT FOR ANSWER CARD: Did you educate on AGS Beers criteria?
12.2. P Thank you. Is there anything else I can I do about my pain?
12.3. NP I would recommend getting Lidocaine ointment 4%, to rub into the areas that hurt most. I am writing it down for you on this 4Ms brochure.
13. What Matters SCREENING
13.1. ANSWER KEYS
13.1.1. Answer Card: Ask What Matters #140
13.1.1.1. KEYWORDS: what, important, concerns, most, desires, wishes, life, care, about,
13.1.1.2. HINT FOR ANSWER CARD: Have you asked what matters?
13.1.2. Enables Card: Independence #125
13.2. NP Mr. Bell, what matters most to you today?
13.3. P Why are you asking me this question?
13.4. NP We ask this and other questions of all older adults. We are committed to providing age-friendly care for every patient 65 years of age and over, and that includes supporting healthy aging.
13.5. NP During your visit today we want to know what matters to you so that we can align your treatment plan with it. Sharing what matters promotes active participation in your health care.
13.6. P Oh, okay then. I have been having trouble with my neighbors complaining that my music is too loud. I have a record collection of all the most famous operas.
13.7. P I treasure my independence and love to go hear opera live, but am having more and more trouble with my walking. So now I just sit at home and choose what music to listen to. I want to return to going out to the opera house independently.
14. What Matters OBSERVATION
14.1. ANSWER KEYS
14.1.1. Answer Card: Independence #125
14.1.1.1. KEYWORDS: happy, listening, alone, personal, space, actualization, self, peace, quiet, [synonyms], active, engaged, participate, walking, mobility
14.1.1.2. HINT FOR ANSWER CARD: What does the patient treasure most?
14.1.2. Enables Card: Integrate What Matters #130
14.2. NP I want to be sure that your care today helps to improve your hearing, and restore your independence, which is what matters to you. Is that what you want from today's visit?
14.3. P Yes, it is important for me to walk to the opera house and enjoy hearing the music.
15. Mentation OBSERVATION - Mood
15.1. ANSWER KEYS
15.1.1. Answer Card: No Mood Abnormalities #14
15.1.1.1. KEYWORDS: passed, normal, sane, coherent, no, depression, dementia, Alzheimer, don't, know, care, flat, affect,
15.1.1.2. HINT FOR ANSWER CARD: What were the results of mood screening?
15.1.2. Enables Card: Education on mood health promotion using the 4Ms brochure #62
15.2. NP Your mood screening indicates that you do not show any symptoms of depression.
16. Mentation ACTION - Mood
16.1. ANSWER KEYS
16.1.1. Answer Card: Education on mood health promotion using the 4Ms brochure #62
16.1.1.1. KEYWORDS: brochure, health, promote, pamphlet, promotion, handout
16.1.1.2. HINT FOR ANSWER CARD: Did you complete mood health education?
16.2. NP The screening we did for mood allows for early recognition and proactive treatment. To support a healthy mood, here are some suggestions that I am highlighting in the 4Ms brochure.
17. What Matters ACTION
17.1. ANSWER KEYS
17.1.1. Answer Card: Integrate what-matters into the care plan #130
17.1.1.1. KEYWORDS: what, matters, important, plan, action
17.1.1.2. HINT FOR ANSWER CARD: Did you integrate what-matters?
17.2. NP I understand that your independence is important to you.
17.3. NP You want to be able to hear and walk better so you can listen to your music at home, and also travel to the opera house.
17.4. NP I think we can create a plan today that continues to support your independence.
18. Mobility ACTION
18.1. ANSWER KEYS
18.1.1. Answer Card: Refer to PT or PCP #65
18.1.1.1. KEYWORDS: physical, therapy, exercise, primary, provider, cane, balance, strength, routine, call, gait
18.1.1.2. HINT FOR ANSWER CARD: Did you offer a referral?
18.2. NP Your walking would improve with physical therapy. I can provide you with a referral for physical therapy to help you improve your mobility and safety, or you can see your PCP for a referral.
18.3. NP A physical therapist would be able to teach you some exercises that could improve your strength and help you be steadier on your feet so you can walk independently to live music events.
18.4. P That is really good to know that maybe my shuffling can be treated and I can get back to my usual activities. I am willing to try physical therapy, and am looking forward to those live concerts! Thanks for the suggestion.
18.5. NP Ok, I will write this information as your mobility plan in the 4Ms brochure.
19. Mobility OBSERVATION
19.1. ANSWER KEYS
19.1.1. Answer Card: Shuffling #37
19.1.1.1. KEYWORDS: unsteady, slow, dragging, deliberate, balance, moving, slowly
19.1.1.2. HINT FOR ANSWER CARD: Did you observe gait?
19.1.2. Enables Card: Refer to PT or PCP #65
19.2. NP I noticed you shuffled into the exam room. Does your joint pain make walking difficult? Are you able to exercise?
19.3. P I have good days and bad days, and I was never really into exercise. When my joints are hurting, I have trouble walking to music events. I love listening to live music, but can't really walk well by myself.
19.4. NP Have you thought about physical therapy to help with your walking?
19.5. P Not really - nobody enjoys physical therapy... but my friend has said great things about her physical therapist.
20. Mentation SCREENING - Memory
20.1. ANSWER KEYS
20.1.1. Answer Card: Mini-Cog performed #137
20.1.1.1. ASSOCIATED KEYWORDS: ask, cognition, perform, appears, card, question, mental, status, health, memory,
20.1.1.2. HINT FOR ANSWER CARD: Have you checked for mood AND memory?
20.1.2. Enables Card: No Memory Abnormalities #138
20.2. NP And now just a few activities for memory screening. We include this because a healthy memory and mood support your physical health.
20.3. 0 Provider performs the Mini-Cog to evaluate the patient's cognition
20.4. 0 Mini-Cog is negative for dementia - Mr. Bell is able to accurately draw a clock face and is able to recall all three words
21. Mentation OBSERVATION - Memory
21.1. ANSWER KEYS
21.1.1. Answer Card: No Memory Abnormalities #138
21.1.1.1. KEYWORDS: passed, normal, sane, coherent, no, depression, dementia, Alzheimer, don't, know, care, flat, affect,
21.1.1.2. HINT FOR ANSWER CARD: What were the results of memory screenings?
21.1.2. Enables Card: Education on memory health promotion using the 4Ms brochure #180
21.2. NP The result of the screening we did of your memory was normal, indicating no further testing is needed at this time. Thank you for your cooperation!
22. Mentation ACTION - Memory
22.1. ANSWER KEYS
22.1.1. Answer Card: Education on memory health promotion using the 4Ms brochure #180
22.1.1.1. KEYWORDS: brochure, health, promote, pamphlet, promotion, handout
22.1.1.2. HINT FOR ANSWER CARD: Did you complete mental health education?