BUILDING A HEALTH HISTORY NURS 6512
Sample Answer for BUILDING A HEALTH HISTORY NURS 6512 Included After Question
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare:
With the information presented in Chapter 1 of Ball et al. in mind, consider the following:
- By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
- 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 social determinants of health?
- What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
- 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 5 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 OF WEEK 1
Post a summary of the interview and a description of the communication techniques you would use with your assigned 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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
Read a selection of your colleagues’ responses.
BY DAY 6 OF WEEK 1
Respond to at least two of your colleagues on 2 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: BUILDING A HEALTH HISTORY NURS 6512
Title: BUILDING A HEALTH HISTORY NURS 6512
Effective quality care begins with obtaining a detailed medical history for the patient. This, therefore, requires developing a therapeutic relationship with the patient to foster trust, which allows the patient to divulge information to build an accurate health history.
Brief summary of interview
The patient in the scenario is an 80-year-old white male with angina who lives on a farm 80 miles away from a healthcare center. The patient present with a complaint of worsening chest pain and a feeling of heavy weight on his chest. He reports a squeezing pain and tightness in the chest that worsen when he does activities around his farm but goes away with rest. Past medical history includes type 2 diabetes, hyperlipidemia, and hypertension. He reports he takes Metformin, Atorvastatin, and lisinopril medication in the morning and evening. He is allergic to penicillin. The patient reports both parents are deceased, but his mother was hypertensive and died from a stroke at 70 years old, while his father had diabetes. The patient reports he smokes 1/2 pack of cigarettes daily, chew tobacco and drinks 1-2 beers with dinner.
Communication technique
Every patient is different, and as such special consideration and care should be taken to identify and address factors that can affect the ability to gather information from the patient. The patient in the scenario is an elderly male, and with older patients, careful attention should be given to the communication techniques used. According to Ball et al. (2019), Communication can be more difficult with the older patient due to the changes in cognitive abilities and sensory deficits. Therefore, in the interview with this patient, communication techniques include speaking clearly and slowly. This allows the patient to gain a better understanding of what is being asked and be able to provide answers. Additionally, identifying if the patient has a hearing deficit and which ear is the stronger side allows for better positioning to ensure the patient can still see the provider’s face and have easier hearing. Sitting close to the patient and providing a quiet area for the interview can enhance the communication process. Older adults may have difficulties with memories or get confused easily, therefore, it is important to use short open-ended questions that are uncomplicated and free from medical jargon when assessing the patient. It also helps the gain collateral information from a relative or caregiver of the patient once permission is obtained, as this can gain greater accuracy and yield more information.
Risk assessment instrument
One risk assessment instrument applicable for this patient is obtaining a personal and social history. Personal and social history helps to obtain information on the patient’s lifestyle habits. This includes nutrition and diet patterns, smoking, and alcohol use, along with self-care habits such as exercise. This assessment instrument must be included as these lifestyle factors are major contributors to the patient’s angina condition. According to Ruan et al. (2018), risk factors such as smoking, alcohol drinking, fruit/vegetable intake (diet), and physical activity (exercise) influence the risk of angina across different ethnic groups. Furthermore, the information is crucial to treating the patient’s condition as he reports smoking and alcohol use. Therefore, providers must establish a baseline of these lifestyle factors to suggest and plan for modifications that can improve the patient’s condition. Significant priority should be placed on optimizing lifestyle factors in addition to preventive medications to reduce complications associated with angina (De Lemos, 2021.) As patient’s get older it is important to have good access to health care resources as their health is at greater risk to deteriorate. The personal and social history consist of the assessment of the patient’s access to care. The patient in the scenario lives far away from the health center. It is important then to assess the patient’s ability to access transportation for care, his regular pattern in seeking care and identify and address any worry the patient might have in regards to his access to care to manage his existing conditions and his present complaint of angina.
Target questions to be addressed to the patient includes:
1)What is the reason for your visit? When did these symptoms start, and is there anything that makes it worse or better?
Do you have any existing medical conditions? Does anyone else in your family has/had these conditions?
Do you smoke/chew tobacco? If yes, what do you smoke, and how much per day?
Do you drink alcohol? How much per day?
How physically active are you on an average day?
What type of diet do you follow at home and outline your average meal for the day.
How often do you seek medical attention and follow up with your doctor?
Explain any alternative therapy or home herbs used to manage presenting symptoms?
References
Ball, J. W., Danis, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s Guide to Physical Examination: An Interprofessional Approach. St. Louis, MO: Elsevier, Inc.
De Lemos, J. A. (2021). Diagnosis and management of stable angina. JAMA, 325(17), 1765. https://doi.org/10.1001/jama.2021.1527Links to an external site.
Ruan, Y., Guo, Y., Zheng, Y., Huang, Z., Sun, S., Kowal, P., Shi, Y., & Wu, F. (2018). Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: results from SAGE Wave 1. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-5653-9Links to an external site.
A Sample Answer 2 For the Assignment: BUILDING A HEALTH HISTORY NURS 6512
Title: BUILDING A HEALTH HISTORY NURS 6512
Hi Devika, as you mentioned, an accurate history assessment is pertinent to getting the patient the proper treatment. Something interesting that I have learned about heart disease is that to some degree or another, every human being on the planet has it and develops it in childhood (Elkins et al., 2019). Atherosclerotic heart disease is on a spectrum and some people are genetically predisposed to having more problems with lipids than others (Elkins et al., 2019). Understanding the patient’s diet is relevant, but if he lives on a farm, he probably eats better than majority of the western population, because he probably eats foods that are less processed and more whole. If that’s the case, very unlikely his heart problem is a diet and exercise issue. Asking if he smokes is such a great question, as it will increase the risk of heart disease and plaque development (Centers for Disease Control and Prevention {CDC}, 2020).
Being that the patient is 80 years old he is part of a generation where smoking was deemed culturally acceptable and was done by many people in his generation (Centers for Disease Control and Prevention {CDC}, 2001). Smoking was responsible for 5 deaths per 100,000 in 1930 to about 76 deaths per 100,000 in 1990 (CDC, 2001). There also maybe toxin in the environment that triggered something. Great post!
References
Centers for Disease Control and Prevention. (2001). Achievements in public health, 1900-1999: Tobacco use — United States, 1900-1999. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4843a2.htm
Centers for Disease Control and Prevention. (2020). Heart disease and stroke. Center for Disease Control and Prevention. Heart Disease and Stroke | Smoking and Tobacco Use | CDC
Elkins, C., Fruh, S., Jones, L., & Bydalek, K. (2019). Clinical Practice Recommendations for Pediatric Dyslipidemia. Journal of pediatric health care : Official publication of National Association of Pediatric Nurse Associates & Practitioners, 33(4), 494–504. https://doi.org/10.1016/j.pedhc.2019.02.009
A Sample Answer 3 For the Assignment: BUILDING A HEALTH HISTORY NURS 6512
Title: BUILDING A HEALTH HISTORY NURS 6512
I just wanted to clarify a statement I made saying all humans have some form of atherosclerotic disease starting in childhood. Some of the reputable sources that I can find relating to this topic don’t outright say that but instead say it may start in childhood for everyone (American Heart Association, 2020). I think it is safe to say that many Americans do not realize that very low-density lipoproteins [VLDL] build up in the endothelium of artery walls much earlier than the manifestation of symptoms (Attia, 2022). Earlier meaning decades earlier, more than likely (Attia, 2022). A study done about 15 years ago shows that 25% of men die of a sudden heart attack between 45 and 54 (Sniderman et al., 2016). Dr. Herbert Starry, a pathologist, who has autopsied the hearts of children and young adults (Attia, 2022). Dr. Stary autopsied the hearts of men and women in their early twenties who died from non-cardiac related events (Attia,2022). These young adults still had silent lesions of plaque buildup in their artery walls and children had minimal cholesterol oxidation in artery walls (Stary, 1999). According to Dr. Ronald Krauss, a lipidologist and a director of atherosclerosis in children at children’ hospital, most of cholesterol in our bodies are produced from the liver and the body has a problem getting rid of ldl so sometimes the smaller particles get stuck inside artery walls (Hoffman, 2018). Not everyone will die from atherosclerotic disease but we all will die with it (Attia, 2022).
References
American Heart Association. (2022, July 20). What is atherosclerosis? www.heart.org. https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/atherosclerosis
Attia, P. (2022, April 28). #203 – AMA #34: What causes heart disease? Peter Attia. https://peterattiamd.com/ama34/#:~:text=%E2%80%9CNot%20everybody%20dies%20from%20atherosclerosis,with%20it.%E2%80%9D%20%E2%80%94%20Peter%20Attia
Hoffmann, T. J., Theusch, E., Haldar, T., Ranatunga, D. K., Jorgenson, E., Medina, M. W., Kvale, M. N., Kwok, P. Y., Schaefer, C., Krauss, R. M., Iribarren, C., & Risch, N. (2018). A large electronic-health-record-based genome-wide study of serum lipids. Nature genetics, 50(3), 401–413. https://doi.org/10.1038/s41588-018-0064-5Links to an external site.
Sniderman, A. D., Thanassoulis, G., Williams, K., & Pencina, M. (2016). Risk of Premature Cardiovascular Disease vs the Number of Premature Cardiovascular Events. JAMA cardiology, 1(4), 492–494. https://doi.org/10.1001/jamacardio.2016.0991
Stary, H. C. (1999). Atlas of Atherosclerosis: Progression and regression. Parthenon.
A Sample Answer 3 For the Assignment: BUILDING A HEALTH HISTORY NURS 6512
Title: BUILDING A HEALTH HISTORY NURS 6512
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