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Difficulty: HardHealth Screening

An occupational health nurse is evaluating a 68-year-old male client during a retirement health assessment. The client's medical record reveals a 35-pack-year smoking history, though he successfully quit smoking 10 years ago. He currently takes no daily medications. The client states, "I feel perfectly healthy, but my wife says I have been misplacing my glasses and forgetting appointments lately. I am sure it is just my old age, so I only came in today to get my updated pneumonia and shingles vaccines."

Based on evidence-based health screening guidelines, which comprehensive plan of care is the most appropriate for this client?

  1. A
    Administer the requested immunizations as primary prevention and reassure the client that his mild forgetfulness is an expected physiological change associated with normal aging.
  2. Provide the requested immunizations, conduct a brief standardized cognitive assessment, and refer the client for a one-time abdominal aortic aneurysm screening ultrasound.Answer
  3. C
    Bypass the requested immunizations to prioritize secondary prevention by immediately initiating a comprehensive diagnostic workup for early-onset Alzheimer's disease.
  4. D
    Schedule the client for an annual low-dose computed tomography scan as primary prevention for lung cancer and delay the immunizations until his memory issues are resolved.

Answer

The nurse should provide the requested immunizations, conduct a brief standardized cognitive assessment, and refer the client for a one-time abdominal aortic aneurysm screening ultrasound.
This plan correctly integrates primary and secondary prevention. The client should receive his requested vaccines (primary prevention). Because he has subjective memory complaints reported by a family member, a brief cognitive screening (secondary prevention) is indicated; memory loss affecting daily life should not be dismissed as normal aging. Furthermore, evidence-based guidelines recommend a one-time screening ultrasound for an abdominal aortic aneurysm (AAA) in men aged 65 to 75 who have ever smoked.

Step-by-Step Solution

1
Analyze the client's risk profile and requested interventions.
The client is a 68-year-old male with a significant smoking history requesting primary prevention (vaccines) and reporting memory concerns.
Establishing a comprehensive risk profile is essential for determining appropriate health maintenance interventions.
2
Determine the appropriate response to the client's memory complaints.
A standardized cognitive screening tool must be administered.
Memory changes that disrupt daily life, such as forgetting appointments, are not a normal part of aging and require secondary prevention screening.
3
Identify specific age and lifestyle-related screening requirements.
The client meets the criteria for a one-time abdominal aortic aneurysm (AAA) ultrasound.
National screening guidelines mandate a one-time AAA screening for all men aged 65 to 75 years who have ever smoked.

Key Concept

Integration of primary prevention (immunizations) with targeted secondary prevention (cognitive screening and AAA ultrasound) based on age, sex, and risk factors.
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Topics

Health Screening

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