Assignment: NURS 6512 week 1 Advanced Health Assessment and Diagnostic Reasoning Building a Comprehensive Health History

Assignment: NURS 6512 week 1 Advanced Health Assessment and Diagnostic Reasoning Building a Comprehensive Health History

Assignment: NURS 6512 week 1 Advanced Health Assessment and Diagnostic Reasoning Building a Comprehensive Health History

Post a description of the interview and communication techniques you would use with your selected patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient

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NURS 6512: Advanced Health Assessment and Diagnostic Reasoning

Building a Comprehensive Health History

Gaining the most information as possible from any patient is ideal.  This allows the advanced practice nurse (APN) to evaluate and gain a better understanding of the patient holistically which fosters a more unobstructed view of their health status to the healthcare professional.  To gain the best knowledge and the most substantial amount of information from the patient, it is essential for the APN to know and utilize communication skills and techniques that are most conducive for the retrieval of patient information.  The purpose of this discussion is to explain how I would conduct an interview to obtain a comprehensive health history for a 76-year-old African-American male with disabilities living in an urban setting. NURS 6512 week 1: Advanced Health Assessment and Diagnostic Reasoning
 Building a Comprehensive Health History

Impact of Age and Disability on Obtaining Health History

When assessing an individual of advanced age, it is important to remain cognizant that there could be barriers in communication from sensory loss.  Because sensory loss is common in elderly individuals, it is essential for the APN to assess each elderly patient in an individualized way rather than overgeneralizing by assuming that they all have sensory loss or deficits.  According to the text of Ball et al. (2015), physiologic age and chronological age are not always parallel nor do age-related changes occur at the same rate in all individuals.  With this knowledge, it is crucial that the APN assess and monitor each elderly patient in an individualized manner so that communication techniques that are patient-specific can be used.  Regardless of age, it is always important to guard against everything that that is said during a patient interview.  According to Ball et al. (2015), the provider is the one in power and the patient is the vulnerable one. NURS 6512 week 1: Advanced Health Assessment and Diagnostic Reasoning
 Building a Comprehensive Health History. Because of this, the patient is often seeking meaning in everything that is said by the APN during the interview which could cause the patient to misinterpret something during the meeting that was intended to be innocuous.

Greeting the Patient

When greeting the patient for the first time, I would first introduce myself while warmly shaking the patient’s hand.  I would then ask my patient how he would like for me to address him.  If individuals are accompanying the patient during the interview, I would likewise introduce myself to those individuals and inquire about their level of involvement with the patient and ensure with the patient that I have permission to speak openly about his health while in the presence of those accompanying him.  I would seat myself comfortably in front of the patient and away from the door.  I would also maintain appropriate eye contact throughout the interview and take notes sparingly to prevent the patient from feeling that I am not focused on the conversation.

Identifying Health Risks

When conducting a comprehensive health history interview, it is essential to consider the patient’s age, gender, ethnicity, and lifestyle to determine what the patient might be at risk for.  For example, according to the article authored by Cordner et al. (2017), African-American males have higher mortality rates than Hispanic and white men due to heightened risk for diabetes, cancer, and heart disease.  According to Dolezsar, McGrath, Herzig, and Miller (2014) 42% of African-American individuals have a diagnosis of hypertension whereas only 28% of Caucasians have a diagnosis of hypertension.  With consideration of this knowledge, it would be prudent for the APN to specifically ask questions that pertain to these risk factors. NURS 6512 week 1: Advanced Health Assessment and Diagnostic Reasoning
 Building a Comprehensive Health History

Communication

During the interview process, I would construct questions so that the answers will yield robust information.  The use of open-ended questions is the ideal method of information retrieval.  Asking the patient, the following question, “What made you come in today?” will likely elicit a broad response.   Additionally, I would try to avoid the use of medical jargon that may confuse the patient or make him feel insecure about his health status.  Disabilities of the patient may impede communication.  Communication techniques should be tailored to overcome communication barriers resulting from disabilities.  Decreased hearing, decreased vision, depression, and neurological impairments are common culprits that can deter the ease of communication or prevent the patient from providing a reliable history (Ball et al., 2015).  If this is the case, other resources can be used to obtain the history.  Other methods of retrieving pertinent patient history include patient records, close family members, and other healthcare professionals that are involved in the patient’s care.

Risk Assessment Instrument

Because falls are a common occurrence in the elderly population I would use a fall risk assessment tool on this patient.  It is that estimated falls create 35 million disabilities worldwide each year (Palumbo, Palmerini, Bandinelli, & Chiari, 2015).  Risk factors for falls include one or more falls in the past year, history of stroke, dementia, Parkinson’s Disease, sensory loss, visual impairments, and the use of an assistive walking device (Ball et al., 2015).  Due to the patient’s age and knowing that he has disabilities, it is reasonable to assume that he is at a high risk for falls. NURS 6512 week 1: Advanced Health Assessment and Diagnostic Reasoning
 Building a Comprehensive Health History.  If the patient is identified as being a fall risk, then interventions can be set in place to help prevent them.

Targeted Questions

After I have introduced myself to the patient and established the best method of overcoming any communication barriers, I will ask the following questions to gain insight about the patient:

• What brought you here today?
• Explain how you feel about your current health status.
• What medical problems do you have now?
• What medical problems have you had in the past?
• What medications do you currently take?
• Describe your level of physical activity.
• Do you have any concerns about your health status?

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.

Cordner A, Wilkie A, Wade T, Hudgens E, Birch R, Gallagher J. Gender and Racial/Ethnic Disparities: Cumulative Screening of Health Risk Indicators in 20-50 Year Olds in the United States. Journal Of Health Disparities Research & Practice [serial online]. March 2017;10(1):126-142. Available from: Academic Search Complete, Ipswich, MA. Accessed August 25, 2018. NURS 6512 week 1: Advanced Health Assessment and Diagnostic Reasoning
 Building a Comprehensive Health History

Dolezsar, C. M., McGrath, J. J., Herzig, A. M., & Miller, S. B. (2014). Perceived racial discrimination and hypertension: A comprehensive systematic review. Health Psychology, 33(1), 20-34. doi:10.1037/a0033718

Palumbo, P., Palmerini, L., Bandinelli, S., & Chiari, L. (2015). Fall Risk Assessment Tools for Elderly Living in the Community: Can We Do Better?. Plos ONE, 10(12), 1-13. doi:10.1371/journal.pone.0146247

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Introduction

A provider who can build a rapport and earn the trust of a patient will meet less resistance when gathering information for health history.  It is essential to look at the whole person, considering factors that could influence the patient’s overall health such as occupation, culture, ethnicity, and socioeconomic status (Ball, Dains, Flynn, Solomon, & Stewart,2015).  The purpose of this discussion is to identify techniques in building a health history for Adolescent Hispanic/Latino boy living in a middle-class suburb.

Patient Scenario

The adolescent patient in this scenario is also Hispanic. First of all, I will find out if he understands English enough to answer my questions during the exam. If he does not, I will arrange for an interpreter. Additionally, I need to be culturally competent. I can do this by being first recognizing that cultural diversity exists, be sensitive to the patient’s heritage, sexual orientation, socioeconomic situation, ethnicity, and cultural background (Ball, et al.,2015) NURS 6512 week 1: Advanced Health Assessment and Diagnostic Reasoning
 Building a Comprehensive Health History

Communication Techniques

An adolescent is a time of life from puberty to maturity. This is the most vulnerable time in a person’s life. Most of them are usually not easy to open up to any conversation. Getting information from them can be quite challenging. It is also essential to provide them with privacy. I will do my best to get the chief concern for seeking care from the parent. If possible, I will request the patient to step out of the room to investigate further. I will begin the conversation with day to day activities in the patient’s life.  I have to remember to respect him and gain his trust. If I am faced with silence, I have to recognize that as well. I will gauge if this silence is out of anger, shame, or just the unwillingness to share. My primary focus will be to find out the details about his concerns and show genuine interest and curiosity.  I will use language that is understandable. I will avoid confrontation. I will listen to what the patient is saying. Once I figure out the chief concern, I can go on to discuss other sensitive issues such as sex, drug, or alcohol use (Ball, Dains, Flynn, Solomon, Stewart, 2015).

Risk Assessment Tool

Knowing the fact that adolescents go for risky behaviors, it will be important to assess him for the same.  I would use the HEEADSSS screening tool for adolescent issues for this. Here I can find out more about his home environment, education, employment, eating pattern, his activities, ambitions. I can also find out about any drug use, his sexuality, or if he has any suicidal thoughts and if he is safe from injury and violence (Ball, Dains, Flynn, Solomon, Stewart, 2015).

Asking appropriate questions and avoiding stereotypes is essential to providing care that is tailored to the individual patient (Ball, Dains, Flynn, Solomon, & Stewart,2015).   Questions should be open-ended and asked in a manner that is easily understood. Some of the questions I would ask him are as follows: 1. What brought you to be seen today? 2. How are things at home?  3. Tell me about your friends. 4. Do you play any type of computer or video games? If so What kind? 5. What are you good at doing?

Thus, I will ask such open-ended questions which will allow my patient to talk about areas that are troubling him if any. NURS 6512 week 1: Advanced Health Assessment and Diagnostic Reasoning
 Building a Comprehensive Health History

Conclusion

A successful interview develops the patient-provider relationship and builds trust. Providing quality individualized care requires an Advanced Practice Nurse to understand not only the disease process but as well as other factors like the culture that will influence the patients’ health, medical care, and healing process.

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.

Cuellar, N. G., Brennan, A. M., Vito, K., & Siantz, M. L. (2008). Cultural Competence in the Undergraduate Nursing Curriculum. Journal of Professional Nursing, 24(3), 143-149. doi:10.1016/j.profnurs.2008.01.004

Flores, G. (2005). The Impact of Medical Interpreter Services on the Quality of Health Care:  A Systematic Review. Medical Care Research and Review, 62(3), 255-299. doi:10.1177/1077558705275416

Kuo, D. Z., O’connor, K. G., Flores, G., & Minkovitz, C. S. (2007). Pediatricians’ Use of

Language Services for Families with Limited English Proficiency. Pediatrics, 119(4). doi:10.1542/peds.2006-1508 NURS 6512 week 1: Advanced Health Assessment and Diagnostic Reasoning
 Building a Comprehensive Health History