Feb 23, 2024 Discussion: Building a Health History NURS 6512
Discussion: Building a Health History NURS 6512 Discussion Building a Health History NURS 6512 The 35-year-old white male with a history of morbid obesity and disability who lives in a remote area learned important details about his particular healthcare requirements and difficulties throughout the conversation. The circumstances of this person are complicated; they include poor physical condition, difficulty accessing assistance because of his remote location, and mental suffering. Various specialized communication skills are necessary to communicate and offer care successfully. The patient’s history of morbid obesity substantially negatively influenced his physical health; it became clear throughout the interview. He mentioned having trouble moving about, joint discomfort, and difficulty walking comfortably. These physical difficulties interfere with his everyday activities and probably impact his mental and emotional health. Living in a remote area only worsens these difficulties by restricting access to social support systems and healthcare services. The patient indicated loneliness and isolation, which are frequent problems for those living in rural locations. His battles with weight and other impairments worsen this mental suffering (Adly et al., 2020). The patient is driven to make good changes in his life, but he also displays poor self-esteem and dissatisfaction from prior efforts to lose weight and improve his general health. The following communication strategies should be carefully used while dealing with this patient in light of these observations: Given the patient’s complicated emotional condition, it’s critical to speak with him in a way that shows you understand him. He may feel various feelings, including irritation, loneliness, and maybe humiliation, due to his experiences with fat, handicapped, and rural life. It will be easier to build rapport and trust if you show empathy by identifying his challenges and confirming his feelings (Chow et al., 2019). It is important to use active listening skills like paraphrase and reflecting remarks continuously. This patient wants to feel that his worries have been acknowledged and taken seriously. He is reassured that his emotions are real through active listening, which promotes honest communication. It is essential to establish a judgment-free atmosphere. In society, obesity may be stigmatized, and those who struggle with it often experience prejudices. A non-judgmental approach guarantees that the patient may talk openly about his weight-related difficulties without worrying about being judged. Concentrating on the patient’s abilities and perseverance is critical while treating his health difficulties. Recognize his desire for good change and assist him in realizing his resources and capacity to overcome challenges. In this situation, cultural competence is very crucial. Rural areas may have their cultural values and traditions. Communication and treatment outcomes may be improved by understanding and honoring these facets of the patient’s culture. The “Edmonton Obesity Staging System (EOSS)” would be a good option to examine the patient’s risk variables. EOSS is a tool created especially for evaluating the danger to one’s morbidity, mortality and financial health implications brought on by obesity (Swaleh et al., 2021). It assesses the patient’s obesity-related health problems and gives a stage, with 0 being the lowest risk and 4 being the highest risk with end-organ damage. The EOSS evaluates the patient’s functional limits, emotional well-being, and physical condition. The EOSS can thoroughly evaluate this patient’s present health state and possible hazards, given his history of morbid obesity, impairments, and mental distress. Targeted Questions How has your weight and physical health affected your daily life and mobility? Can you describe the emotional challenges you’ve faced due to your weight and disabilities? What resources or support networks do you have access to in your rural community? Have you previously sought medical or therapeutic assistance for weight management or emotional well-being? What are your goals and aspirations for your health and quality of life moving forward? These targeted questions aim to delve deeper into the patient’s physical and emotional struggles, assess his access to resources, understand his past healthcare experiences, and identify his aspirations for the future. These insights will guide the development of a tailored care plan that addresses his unique needs and challenges. References Adly, N. N., Abd-El-Gawad, W. M., & Abou-Hashem, R. M. (2020). Relationship between malnutrition and different fall risk assessment tools in a geriatric in-patient unit. Aging clinical and experimental research, 32, 1279-1287. Chow, R. B., Lee, A., Kane, B. G., Jacoby, J. L., Barraco, R. D., Dusza, S. W., … & Greenberg, M. R. (2019). Effectiveness of the “Timed Up and Go” (TUG) and the Chair test as screening tools for geriatric fall risk assessment in the ED. The American journal of emergency medicine, 37(3), 457-460. Swaleh, R., McGuckin, T., Myroniuk, T.W, Manca, D., Lee K., Sharma, A.M, Campbell-Scherer, D., & Yeung, R.O. (2021). Using the Edmonton Obesity Staging System in the real world: a feasibility study based on cross-sectional data. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8673483/ Building rapport with the patient As advanced practice registered nurses (APRNs), it is imperative to obtain a thorough health history from the patient interview process. The history is vital to guiding the physical examination and to interpreting physical exam findings ( Ball et al., 2019). One way to effectively build a health history during the interview process is to develop a rapport or relationship with the patient. Establishing a positive patient relationship depends on effective communication built on courtesy, comfort, connection, and confirmation (Ball et al., 2019). Each patient is unique and must be treated as such. Communication and interview techniques for building a health history can differ with each patient based on age, learning abilities, and the patients’ reading level. The purpose of this discussion is to identify techniques in building a health history with an adolescent white male with no insurance seeking medical care for an STI. Crucial factors of consideration According to the World Health Organization (WHO), adolescence is the phase of life between childhood and adulthood, from ages 10 to 19. It is a unique stage of human development and an important time for laying the foundations of good health (2022). Even through the adolescent years, there are significant diseases/illnesses and injuries. During this phase, adolescents establish patterns of behaviour – for instance, related to diet, physical activity, substance use, and sexual activity – that can protect their health and the health of others around them, or put their health at risk now and in the future (WHO, 2022). During the adolescent phase, it is important to provide correct age-appropriate sexual activity information. Assessment The collection and analysis of information regarding an individual’s current and overall health is a health assessment and is provided by the patient subjectively (Ball et al., 2019). Considering this patient is coming to the appointment for concerns for an STI, it is imperative for the APRN to not be judgemental. This will allow the patient to feel comfortable sharing information such as signs and symptoms of the probable STI, number of partners, past history of an STI, and their gender identity. The physical assessment is just as important as obtaining a health history. Physical exams should include inspection, auscultation, percussion, and palpation of the patient to verify the patient’s report objectively (Ball et al., 2019). As part of the physical assessment, the APRN may also conduct a male genitalia examination and obtain cultures of fluid to test for certain STIs such as, chlamydia, gonorrhea, and syphilis. Labs may also be ordered to check for those certain STIs. At the end of the examination, targeted needs would be beneficial to address. For example, this patient does not have medical insurance. Since the patient is an adolescent, one would assume they are on their parent’s medical insurance as a dependent. Sometimes, adolescents are too afraid and uncomfortable to tell their parents and/or guardians any reproductive issues. Oftentimes, adolescents come into clinics secretly and say they do not have medical insurance so their parents/guardians do not find out about the visit once billed. Asking questions such as why don’t you have insurance? Do your parents/guardians have medical insurance? Do they know about your visit to the clinic today? Can help identify any patterns or concerns without being assumptive. Providing support and comfort can help alleviate any hesitancy in answering the above questions. Finding and establishing important resources can help make sure the patient is getting the care they need outside of the clinic. Specific targeted questions Asking appropriate questions and avoiding stereotypes is essential to providing care that is tailored to the individual patient (Ball et al., 2015). With this particular patient, sexual information should be obtained in a non-judgemental manner. Targeted questions such as 1) What brings you to the clinic today? 2) How many partners do you currently have? 3) What are your current sexual practices (anal, oral, vaginal)? 4) What protection do you use to prevent STIs? 5) Have you had any STIs in the past? 6) What are your symptoms? And when did they start? Utilizing the screening tool PACES would also be beneficial for this patient. PACES stands for parents/peers, accidents/alcohol/drugs, cigarettes, emotional issues, and sexuality/school (Ball et al., 2019). PACES identifies these categories specifically for adolescents because oftentimes they are what is important to this age group. Conclusion A successful health assessment and interview process between an APRN and their patients requires a good rapport/relationship as the foundation. Identifying considerations and tailoring specific targeted questions to individual patients can be beneficial. Patient-centered care is an important contributor to a positive patient care experience (Dang et al., 2017). Actively engaging and listening to each patient is important. This will help the patient feel more comfortable expressing their concerns and needs. References Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby. Dang, B. N., Westbrook, R. A., Njue, S. M., & Giordano, T. P. (2017). Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC medical education, 17(1), 1-10. World Health Organization. (2022). Adolescent health. Retrieved from https://www.who.int/health-topics/adolescent-health#tab=tab_1 By establishing a good rapport with your patient, you could effectively gather important health information from him, which enabled you to identify and educate your patient about potential health-related risks. Your communication techniques allowed your patient to open up and share more pertinent information essential for his care. You actively listened to your patient and were non-judgmental. At all times, to keep your patient comfortable, you were aware of your facial expressions, where you sat, the distance from your patient, your nonverbal cues which complemented your listening, the manner you asked the questions, and how often you looked at your computer to take notes. That showed you were really present in the room, open and engaged with the patient leading to a trust-enhancing or even therapeutic exchange (Ball et al. 2019). You knew that discussing sexually transmitted diseases (STDs) was a sensitive topic for an adolescent patient; you addressed the subject respectfully while offering constant help and support to your patient. You maintained the patient’s privacy and were willing to ask his parents (if they were with him) to leave the room, prioritizing your patient preference and autonomy to engage him in his care. You educated your adolescent patient about safe sex at his education level; you purposefully avoided the utilization of medical jargon and utilized words that your patient was able to understand to avoid confusion and anxiety. You explained to your patient that you were asking him very personal questions to identify risks, to allow him to discuss his concerns, and to create his care plan (Ball et al., 2019). Summarizing and clarifying what you have discussed with your patients are Discussion Building a Health History NURS 6512 perfect ways of confirming the patient’s understanding, alleviating the patient’s fear, and, with further exploration helping the patient voice his concerns (Ball et al., 2019). This will engage the patient to participate in his plan of care. The 5 P’s of sexual history is a very good approach that allows you to discuss important areas with your patient. Your targeted questions were open-ended. I would have asked the patient for his sexual orientation and his gender to appropriately continue to offer care to him (Ball et al., 2019). I would ask if he is still sexually active. In what way? What is the frequency of his intercourse? These questions help “Identify risk factors for unintentional pregnancy and sexually transmitted infections (STIs) as an important part of the sexual history” (Ball et al., 2019, p.11). I would have mentioned to the patient that I would have an extra care worker or chaperone in the room during the (intimate) exam. “A chaperone is encouraged to be present in any medical consultation, especially when an intimate examination is required. This impartial attendant could reassure the patient, especially when gender is an issue, and may avoid conflicts in the patient-physician relationship. Situations where a chaperone is unavailable or is declined by the patient present special ethical problems and may impinge on an appropriate therapeutic relationship, the patient-physician relationship” (Chandramani et al., 2017). Thank you for your educational post. References Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Chandramani, T., Sivalingam, N. & Davendralingam, S. (2017). The Chaperone in a therapeutic relationship: A critical discussion. International Journal of Person-Centered Medicine, 7(1), 53-60. I enjoyed reading your post about communication with an 85 year old patient. It is important to build a report with the patient so they feel comfortable speaking with you. When evaluating the patient to find out if they are mentally intact it is important to not lead them to answers. Even though the patient has a decline in her health she may be mentally still intact. Open ended questions are important because it allows the patient to express themselves. This may help you find out if they are understanding the question or are they trying to hide any deficits. Using closed ended questions can also help you identify how their memory is. Providing questions with random words to remember will help you assess this piece of brain functionality when it comes to remembering things. It is important to know where the patient is at with memory and cognitively because this can raise some red flags when it comes to safety in their home. When I worked in home care as a care coordinator I had done many evaluations of elderly people in my community to see if they are safe to be at home or are they needing a different level of care. I was able to help family members realize safety concerns for the patient by being able to do these assessments. One question that ended up coming up a lot was will the patient remember they are cooking something or are they at risk of starting a fire. During one of my evaluations I ended up finding that the patient was not safe to cook in the home. I ended up having to unplug the stove and the other cooking devices with the help of the family members until they were able to get the patient placed with a higher level of care. It would also be important to do a fall assessment on this patient to see if there are risks for falls and if the patient did have a fall would their be away they could alert someone if they got injured. Walking around and doing a survey of the home was part of these assessments. I also observed the patient while they went about doing their normal routine without correcting them because I would want to see what they would do if I was not there. If it became too much of a risk than I would stop and make note of findings while making sure the patient is safe. When asking the patient questions, I will not dominate the conversation. I will actively listen by providing non-verbal cues to the patient that shows that I am listening to the patient when they are speaking while not leading the patient to answers during the evaluation of their safety in their home. References: Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s Guide to Physical Examination: An interprofessional approach (9th ed.). Elsevier. Mayo Foundation for Medical Education and Research. (n.d.). Physical Medicine and Rehabilitation. Mayo Clinic. Retrieved June 4, 2022, from Week 1 Nurs-6512N-47 Advanced Health Assessment Obtaining a comprehensive health history for a patient is critical in developing a treatment plan for them. The goal of this discussion post is to go over interview techniques that I would use with an 85-year-old white female living alone who is in poor health. I’ll discuss the risk assessment instrument I’d use and why. Finally, I’ll list five specific questions I’d ask to assess her health and begin compiling a health history. The first meeting with any patient is critical for establishing a positive relationship and partnership from the start (Ball et al., 2019). There will be a lot to consider when interviewing this patient because she is 85 and lives alone. I’ll need to determine how mentally prepared she is, whether she has hearing issues, and how much she understands about her health. Older adults frequently believe that certain issues are simply part of aging and should not be addressed (Ball et al., 2019). Agism is frequently experienced by older adults (Garrison-Diehn et al., 2022). Even in health-care settings, older people have feelings of incompetence and burden (Garrison-Diehn et al., 2022). It will be critical to ensure that she feels at ease speaking with me, knowing that there will be no bias or judgment. To create an accurate health history for your patient, good communication skills are required. A detailed health history is important to establish when caring for your patient, this allows you paint a detailed picture of the patient’s health history and aids in building a relationship with the patient. “The collection of family health history information is part of routine health care interactions and can inform clinical decision making and preventive services.” “(Lushniak, B. 2015.) Health risk assessments are important because this gives us the opportunity to obtain a detailed collection of the patient’s family history and the patients risk for chronic diseases. (Wu. R. 2015. Para. 1.) Case B focuses on building a health history for 14-year-old biracial male living with his grandmother in a high-density public housing complex. This patient is in the adolescence stage of his life, this can promote barriers to obtaining vital information. Adolescence is time from puberty to maturity, this is the most vulnerable time of a person life and puts them at risk of risky behaviors. (Ball, J. 2019. Pg. 17.) This patient is subjected to peer pressure, which can lead to risky behavior such as drug use, alcohol use, and unprotected sex. A screening tool for adolescents that would be useful is the PACES screening tool, which stands for Parents/peers, alcohol/drugs, cigarettes, emotional issues, and school/sexuality. This screening tool assess any alcohol/drug abuse, risk for sexually transmitted disease, assess the relationship with the patient’s parents, and risk of depression. Assess the educational needs of the patient and the reading level. Because this patient is only 14 years old, it would be best to avoid any medical jargon that the patient may not understand. Too many big words may push the patient away and create barriers. Another helpful communication technique would be to use open ended questions. This allows for more information to disclosed and allows the patient open up about things. 5 questions I would focus on are: How is your home life while living with your grandmother? How are you doing in school? Tell me about your friends? What kind of things are you pressured in doing by your friends? Are you ever influenced to use drugs or alcohol? Do you feel depressed or alone? Discussion: Building a Health History NURS 6512 Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks. For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor. Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Building a Health History NURS 6512 Read Also: NRNP 6640 Week 11 Discussion: Therapy for Clients with Personality Disorders Struggling to Meet Your Deadline? Get your assignment on Discussion: Building a Health History NURS 6512 done on time by medical experts. Don’t wait – ORDER NOW! Meet my deadline
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