Sample Answer for NUR 590 Discussion Building a Health History Included After Question
Discussion: Building a Health History
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 one of the following new patients:
76-year-old Black/African-American male with disabilities living in an urban setting
Adolescent Hispanic/Latino boy living in a middle-class suburb
55-year-old Asian female living in a high-density poverty housing complex
Pre-school aged white female living in a rural community
16-year-old white pregnant teenager living in an inner-city neighborhood
To prepare:
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With the information presented in Chapter 1 in mind, consider the following:
How would your communication and interview techniques for building a health history differ with each patient?
How might you target your questions for building a health history based on the patient’s age, gender, ethnicity, or environment?
What risk assessment instruments would be appropriate to use with each patient?
What questions would you ask each patient to assess his or her health risks?
Select one patient from the list above on which to focus for this Discussion.
Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
Select one of the risk assessment instruments presented in Chapter 1 or Chapter 26 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.
By Day 3
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.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different days who selected a different patient than you, using one or more of the following approaches:
Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
Suggest additional health-related risks that might be considered.
Validate an idea with your own experience and additional research.
A Sample Answer For the Assignment: NUR 590 Discussion Building a Health History
Title: NUR 590 Discussion Building a Health History
Building a Health History
Scenario: 76-year-old Black/African-American male with disabilities living in an urban setting
A Description of the Interview and Communication Techniques for this Patient
According to Ball, Dains, Flynn, Soloman, and Stewart (2015), the first meeting of a patient and a clinician sets the tone of the relationship between the two individuals regardless of other dynamics. However, seeing that this is an elderly patient consideration of cognitive disabilities such as limited vision, hearing loss, and possible deterioration of comprehension skills should be taken into consideration (Ball, Dains, Flynn, Soloman & Stewart, 2015). Sensory loss can make communication and the interview process rather difficult and tedious leading to a mislay of the major reason for the initial visit (Deck et al., 2015). The interview setting would be a quiet room, face to face communication, speaking slowly, clearly, using simple terms with a possible close family member for history assistance. The comprehensive geriatric assessment (CGA) too, would be utilized that give a structured approach to identify, prioritize and manage the disease processes and therapeutic interventions of the elderly (Seematter-Bagnoud & Büla, 2018).
Explain, Identify, and Justify the Risk Assesment Instrument and Why it Applies to the Chosen Patient
When using CGA, the clinician screens the patient for functional impairment asking questions regarding activities of daily living (ADL’s) such as bathing, dressing, toileting, transferring, continence, eating, preparing meals, medication distribution, and transportation (Seematter-Bagnoud & Büla, 2018). A screening for depression and social isolation due to the significance for depressive disorders on 10-15% of older adults (Seematter-Bagnoud & Büla, 2018). A screening of cognitive impairment due to the prevalence of dementia in 5% of adults aged 65-70 to 30-40% in 90 years and older (Seematter-Bagnoud & Büla, 2018). A test called the Mini-Cog is used on these patients that is comprised of a three-word recall test within a clock drawing (Doerflinger, 2017). Impaired cognition is suspected when a patient is unable to recall any or either one or two words and must follow up with neuropsychological testing to rule out dementias or Alzheimers (Doerflinger, 2017). A screening for sensory impairments such as vision and hearing that can impact communication on specifically how to take a certain medication (Seematter-Bagnoud & Büla, 2018). Screenings for nutritional problems, where malnutrition can m be triggered by medications, chronic illness, socioeconomic and psychological issues (Seematter-Bagnoud & Büla, 2018). Finally, a fall risk assessment due to one in three persons 65 years and older falls every year with one in ten having significant debilitating injuries (Seematter-Bagnoud & Büla, 2018). The current patient is a prime candidate for this screening tool.
Five Targeted Risk Assessment Questions
1. Do you have difficulties with ADL’s? (ex. bathing, dressing, making meals, taking medications, transportation)
2. Can you recall three words in this clock drawing? (Mini-Cog Test)
3. In the past two weeks have you had little interest in doing things, feeling down, depressed, or hopeless?
4. How is your vision and hearing? (perform an Snellen eye chart trail and whisper in each ear)
5. How are your eating habits? Any unexplained weight loss? Do you shop for and prepare your own meals? (body mass index performed)
6. Do you have problems with your gait? Do your have stairs in your house? Do you walk with a walker or cane?
7. Who do you live with? Do you have someone to take care of you if you get sick? Who can make decisions for you is you were unable to?
Overall, the CGA assessment instrument focuses on function-related outcomes, underlying causes, and multiple chronic disorders in older people(Seematter-Bagnoud & Büla, 2018). CGA reduced disability, extended home-stay, and reduced the institutionalized rate by 20% when intitiated in community dwelling hospitalized older adults (Seematter-Bagnoud & Büla, 2018). CGA decreased the risk of hospital and nursing home admissions. Finally, for general practice physicians, withCGA medical problems were managed within 12 months of diagnosis which improved quality of care including reductions of falls and quality of life (Seematter-Bagnoud & Büla, 2018).
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.
Deck, L., Akker, M., Daniels, L., DeJonge, E. T., Bulens, P., Tjan-Heijnee, V., L Van
Abbema, D, & Buntinx, F, (2015). Geriatric screening tools are of limited value to
predict decline in functional status and quality of life: results of a cohort study. BMC
Family Practice, 16(30), 1-12. Doi 10.1186/s12875-015-0241-x. Retrieved from
http://bmcfampract.biomedcentral.com/articles/10.1186/s12875-015-0241-x
Doerflinger, D. C. (2017). ConsultGeri. Retrieved from https://consultgeri.org/
Seematter-Bagnoud, L., & Büla, C. (2018). Brief assessments and screening for geriatric
conditions in older primary care patients: a pragmatic approach. Public Health
Reviews, 39(1). doi:10.1186/s40985-018-0086-7
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