NURS 6512: Building a Health History; Advanced Health Assessment and Diagnostic Reasoning

NURS 6512: Building a Health History; Advanced Health Assessment and Diagnostic Reasoning

NURS 6512: Building a Health History; Advanced Health Assessment and Diagnostic Reasoning

Building a Health History

Factors such as ethnicity, gender, environment, and age can influence a patient’s illness or health status. Advanced practices nurses should take these factors into consideration when communicating with their patients to accurately obtain a detailed history. It is essential to use communication techniques tailored for each patient to effectively build a partnership and trusting relationship (Ball, Dains, Flynn, Solomon, & Stewart, 2015). Consider the following patient, an adolescent Hispanic/Latino boy living in a middle-class suburb. Adolescence differs from adulthood and childhood psychosocially and physically (Ball et al., 2015). Experimentation with risky behaviors often occur during adolescence and are dependent on factors such as peer pressure, school performance, self-esteem, parental attachment, extracurricular activities, and social media (Denham, 2014). While adolescent patients are more likely to engage in risky behavior, Denham (2014) found that Hispanic adolescents perceived a higher level of risk associated with binge drinking and therefore were less likely to engage in that particular behavior Building a Health History Essay – NURS 6512: Advanced Health Assessment and Diagnostic Reasoning. Considering the environment that the patient lives in is also useful for determining what might influence health or illness. A middle-class suburb suggests that this patient most likely has access to health care, education, and community resources enabling a healthy lifestyle.

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Ball et al. (2015) suggest communication techniques that encourage adolescent patients to discuss their concerns without forcing them to talk. Adolescent patients value confidentiality and a safe environment to openly discuss their concerns (Ball et al., 2015). Use of open ended questions is imperative when communicating with adolescent patients. Being respectful, flexible, and confidential are important aspects of the communication process when interviewing an adolescent patient. Building a Health History Essay – NURS 6512: Advanced Health Assessment and Diagnostic Reasoning. One technique suggested by Ball et al. (2015), when communicating with adolescent patients is the use of a pre-visit questionnaire. This allows the patient to identify any concerns they have prior to a verbal conversation and provides a tool the provider to develop appropriate questions for each patient. The questionnaire should address highly charged issues faced by adolescents such as pregnancy, smoking, substance use and abuse, friends, bullying, sexual activity, weight or height concerns, menstruation, and so forth (Ball et al., 2015). Initially engaging the patient in discussion regarding day to day experiences is an effective way to open up the communication process.

Risk Assessment Instrument

Typically, adolescence is not a period of time when illness is often present. Growth and development occurs during adolescence and threats to health are often related to developmental pressures, both physical and social exploration and experimentation, and risky behaviors (Rayner & Crossen, 2014). According to Rayner & Crossen (2014), accidents, injuries, mental health problems, substance use, and unprotected sex are the major causes of mortality and morbidity in adolescent patients. HEEADSSS is a specific screening tools for adolescent issues used to obtain a psychosocial history allowing the advanced practice nurse to identify problems or potential problems (Ball et al., 2015). HEEADSSS addresses the home environment, education/ employment, eating, activities, drugs, sexuality, suicide/depression, and safety from injury and violence (Ball et al., 2015). HEEADSSS is an appropriate risk assessment tool for the adolescent Hispanic/Latino boy living in a middle-class suburb. This patient is most likely not to have significant health issues and therefore should be screened for potential issues that impact adolescent health. Building a Health History Essay – NURS 6512: Advanced Health Assessment and Diagnostic Reasoning.

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Targeted Questions

Targeted questions for the adolescent male Hispanic/Latino patient include the following:

• Where do you live, do you have your own room, and who lives with you?
• How are things at home? What are your relationships like?
• How is school going, what classes do you like best and least?
• How do you feel about your body? What do you like and not like about it?
• How much exercise do you get each week and how do you feel about the food you eat?
• What do you and your friends do for fun?
• Do you participate in sports?
• Do any of your friends or family members use tobacco? Alcohol? Drugs?
• Do you use tobacco? Alcohol? Drugs?
• Have you ever been in a romantic relationship?
• Are you sexually active?
• Do you ever feel sad or down more than usual? Any trouble sleeping?
• Building a Health History Essay – NURS 6512: Advanced Health Assessment and Diagnostic Reasoning

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Denham, B. E. (2014). Adolescent Perceptions of Alcohol Risk: Variation by Sex, Race, Student Activity Levels and Parental Communication. Journal of Ethnicity in Substance Abuse, 13(4), 385-404 20p. doi:10.1080/15332640.2014.958638

Rayner, G., & Crossen, K. (2014). Can a paediatric department provide health care for vulnerable adolescents?. The New Zealand Medical Journal, 127(1398), 67-76. Building a Health History Essay – NURS 6512: Advanced Health Assessment and Diagnostic Reasoning