NURS 6512 Discussion: Building a Health History

A 80-year-old white male with angina who lives on a farm 80 miles away from a healthcare center.

The patient is an 80-year-old white male with angina who lives on a farm 80 miles away from a healthcare center. The patient interview would be set up without any bulky furniture or equipment in the way of the interviewer and the patient. There is a high risk of sensory loss and visual impairment due to the patient’s age (Daly,2017) It would be assured that eye contact is maintained during the interview and that the face is clearly visible so that the patient can interpret lips in the event of hearing loss. In case the patient has any type of sensory loss, which is typical in old age, speech would be clear and slow (Daly, 2017). A written interview with the c would be suggested. If the patient wishes, a written interview with the patient would be proposed, with forms customized to accommodate the needs of visually impaired elders. The interview would begin wit

NURS 6512 Discussion Building a Health History

h the introduction of the interviewer and role to the patient and any accompanying person present The patient’s name, as well as how they prefer to be addressed, would be requested. The purpose for the visit would be inquired about. Active listening will be employed and extra time would be taken to listen to the patient as there is a chance that the patient is suffering from memory loss as a result of aging. It is very essential to promote person-centered care (Dickson et al 2017). For attentive listening, skills such as summarizing, paraphrasing, and clarifying would be useful (Jack et al, 2019). Both the verbal and non-verbal clues of the patient will be noted (Croston, 2018).

It would also be noted that there is a possibility of symptoms being vague due to age Using open-ended inquiries, it would be ensured that all symptoms are discussed and that none are neglected by the patient. The capability of the patient to join in the decision-making will also be examined and necessary steps will be taken in absence of the cognitive capability. If family members are present they will be consulted in order to clarify possible discrepancies or fill in the gaps. The chief concern of the patient’s visit will be found out. The patients’ angina history and bouts, as well as their likely trigger and what relieves it, will be investigated. The functionality assessment of the patient is also paramount due to the age of the patient. Personal and social history and review of systems are properly addressed. Heart and chest-related questions would be asked for a review of systems. To guarantee that the patient’s actual feelings are conveyed, the inquiries would be as open-ended as feasible. A summary of want the patient said would be given and the patient would be asked if there are any other issues to ensure that all of their concerns are addressed.

In order to build effective communication with the patient, It would be ensured that the communication technique is

NURS 6512 Discussion Building a Health History

built on courtesy, comfort, connection, and confirmation (Ball et al, 2018). These are applied to get the patient to trust and confide in the nurse. It helps to calm the patient and in return, they are willing to answer and are responsive to questions.

The risk assessment instrument used for the patients is that of older adults. This is because the patient is 80years old and thus falls into the category of older adult

Five targeted questions that can be asked of the patient includes:

What brings you here today?: This question would be asked in order to prompt the patient to explain the primary reason for the visit. Giving the patient leeway to describe concerns. This alongside follow-up questions would help to detect the chief concern for seeking care.

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When did you last feel well?: This question would be asked in order to gain a history of the Illness of the patient. This would help to trace the beginning of the ailment, complete description of the first symptoms, duration, and so on in order to follow the chronological progression of the ailment.

What does a typical angina attack feel like? : This is to get an adequate description of the attack, its persistence, how often it occurs, and what could possibly induce the attack or relieve it.

Tell me what a typical day is like for you: This will provide details on the ability of the patient to take care of their daily needs, giving a basic review of systems. It will give an idea of the environment in which the patient resides. This question alongside follow-up questions will also aid with the provision of the social and personal history of the patient. It would also help to know how involved the patient is with the farm on which he lives. It can also provide details on the habits, environment, and needs of the patients and how they maintain function.

Is there anything else that you want me to know? : This is to ensure that all the concerns of the patient have been addressed.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2018). Seidel’s guide to physical examination (9th ed.). Mosby.

Daly, Louise (2017). Effective communication with older adults. Nursing Standard, 31(41), 55–63. doi:10.7748/ns.2017.e10832

Jack, Kirsten; Ridley, Caroline; Turner, Samuel (2019). Effective communication with older people. Nursing Older People, 31(4), 40–48. doi:10.7748/nop.2019.e1126

Dickson M, Riddell H, Gilmour F et al (2017) Delivering dignified care: a realist synthesis of evidence that promotes effective listening to and learning from older people’s feedback in acute care settings. Journal of Clinical Nursing. 26, 23-24, 4028-4038.

Croston M (2018) Communication. In Tetley J, Cox N, Jack K et al (Eds) Nursing Older People at a Glance. Wiley-Blackwell, Oxford, 6-7

Main post

COLLAPSE

Case Overview

The patient is a 21-year-old Filipino college student. She resides in the college dormitories. She visited the clinic to initiate oral contraceptives as a family planning method.

How Communication and Interview Techniques Would Differ With Each Patient

Historically, nurses use a clinician-centered interviewing technique to understand patient issues within a biomedical health model. This approach strictly contextualizes a patient by disease but does not incorporate a patient’s social and psychological factors, which could be the primary determinants of health. Over the years, with the call for a more patient-centered approach, nurses have adopted a more integrated interviewing approach, which incorporates all the dimensions that influence a patient’s well-being. During interviews, the nurse should use both open-ended and close-ended questions. The former would require the patient to give a detailed response while the latter would require specific answers structured in terms of, yes or no responses. Such questions are important in obtaining specific information (Peate, 2019). When interviewing adolescents, the nurse should guarantee them confidentiality on the environment and the information shared. On the contrary, when interviewing children/infants or very elderly patients, the nurse will obtain the history from primary caregivers.

During the interview, the nurse should pay attention to both verbal and non-verbal cues and demonstrate active listening. For the assigned patient, it will be important to use simple and easy language for the patient to understand. Language is a key determinant for effective communication and understanding especially for patients who are not native English speakers. Healthcare workers are often tempted to use medical jargon when interacting with patients (Peate, 2019). It creates a scenario of patient alienation and increases the incidences of misinterpretation. In addition, I will use an empathetic tone when communicating. It is important to use warm and friendlier tones when during the therapeutic interaction, as this will convey a message of care to the patient allowing them to be more comfortable and free to share information. For this patient, I would ask the following target questions during history taking.

Inquiring about the social determinants of health is important as it is an important health determinant. Ask about where they were born, surrounding physical environment; both current and where they grew up in, availability of social support, availability of health care facility and services and if the patient has any underlying stressful factors.

Some of the questions that can help in assessing the risk of a patient include; dietary and lifestyle habits, underlying chronic illnesses in the family, past medical history, current medication history, the sexual history, engaging in physical activity, substance abuse and the current living environment.

Since the patient is sexually active, he is at an increased risk of getting sexually transmitted infections. According to, Shannon & Klausner, (2018) there is an increase in the number of sexually transmitted infections that is more pronounced in adolescents between 15-24 years. Adolescents make up for approximately half of the new sexually transmitted infections in the US.

Given that the patient is an adolescent, it is important to assess hi mental health. According to CDC, the number of adolescents reported to have mental health problems is increasing. The HEEADSSS is an acronym for home, education/employment, eating, activities, drugs, sexuality, suicide/depression and safety, a physcosocial assessment of the wellbeing of adolescent and identify risks.

When was your last normal menstrual period (LMP)?
Do you have any allergies to foods and drugs?
Are you currently sexually active?
Are you currently taking any prescription or OTC drugs?
Do you have any chronic illnesses such as heart disease, liver disease, diabetes, migraines, or coagulation disorders?

Before determining the kind of contraception to give, it will be important to perform various exams and tests to assess for eligibility. The most important are a pregnancy test and a pelvic exam (World Health Organization, 2018). Besides, the question to determine the LMP will help to establish the possibility of a pregnancy. Women with a history of cardiovascular disease, hypertension, smoking, coagulation disorders, and liver disease have higher risks of adverse events associated with oral contraceptives, which renders them illegible (Tolu, 2020).

References

P Peate, I. (2019). Taking a patient history and physical examination. Learning to Care: The Nurse Associate,96.https://books.google.com/books?hl=en&lr=&id=fTqDDwAAQBAJ&oi=fnd&pg=PA96&dq=communication+tips+during+patient+history+taking&ots=k24ROBDpF-&sig=GSqdhjNIxjKAXJp8d_HiOP6qEe8

S Shannon, C. L., & Klausner, J. D. (2018). The growing epidemic of sexually transmitted infections in adolescents. Current Opinion in Pediatrics, 30(1), 137–143. https://doi.org/10.1097/mop.0000000000000578

Tolu, L. B., & Feyissa, G. T. (2020). Guidelines and best practice recommendations on contraception and safe abortion care service provision amid COVID-19 pandemic: Scoping review. https://www.researchsquare.com/article/rs-25326/latest.pdf

World Health Organization. (2018). Implementation guide for the medical eligibility criteria and selected practice recommendations for contraceptive use guidelines: a guide for integration of the World Health Organization (WHO) Medical eligibility criteria for contraceptive use (MEC) and Selected practice recommendations for contraceptive use (SPR) into national family planning guidelines. https://apps.who.int/iris/bitstream/handle/10665/272758/9789241513579-eng.pdf

Week 1 Original Post

COLLAPSE

Week 1 Discussion- Original Post

The purpose of this discussion is to obtain a health history and history of presenting problems in an 80-year-old white male with angina who lives on a farm 80 miles away from a healthcare facility.

During the interview with this particular patient, it is important that it is performed in a quiet, well-lit room, and you are positioned in front of the patient and have access to pen and paper in case the patient is hard of hearing (Ball et al., 2017). I would introduce myself and my role and ask the patient his name and what he prefers to be called (Ball et al., 2017). After establishing that the patient came to be seen for angina, it would be crucial to obtain a history pertinent to the chest pain including onset, quality, what the patient was doing when the pain started, and if he had ever experienced pain like this in the past as well as any exacerbating or alleviating factors (Ball et al., 2017). Vital signs should be reviewed and a 12 lead EKG should be obtained. The patient’s past medical history should be reviewed as well as medications to determine if the patient has a history of coronary artery disease or has ever had any coronary stents placed and if the patient is on any antiplatelet medications. By gathering information such as vital signs, EKG, past medical history including diabetes, heart disease as well as smoking, exercise, and weight, The Framingham Global Risk Assessment could be obtained to determine the patient’s risk of acute coronary syndrome (Pearson, 2002). This information is important to gather because acute coronary syndrome could be life-threatening and an ST elevated myocardial infarction needs immediate percutaneous coronary intervention.

All patient interactions and assessments should be centered around the patient’s specific goals and life expectancy, especially given this patient’s age (Tatum Lii et al., 2018). It is important to determine the patient’s goals of care prior to developing a treatment plan and discuss code status in the event of an emergency (Dyck & Fried, 2021). The targeted questions I would ask this patient are 1) How would you rate your chest pain on a scale of 0-10 and what does it feel like? 2) Do you have any shortness of breath, feel nauseous or sweaty? 3) In the event you need emergency medical care, would you want to be transferred? 4) Do you have an emergency contact or next of kin? 5) What is your code status? I believe these are the most necessary questions to determine what steps to take to get the patient the treatment they need or whether medical management is appropriate.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2017). Seidel’s guide to physical examination – e-book: An interprofessional approach (mosby’s guide to physical examination) (9th ed.). Mosby.

Dyck, L. I., & Fried, T. R. (2021). Prognostic information, goals of care, and code status decision‐making among older patients. Journal of the American Geriatrics Society, 69(7), 2025–2028. https://doi.org/10.1111/jgs.17080

Pearson, T. A. (2002). New tools for coronary risk assessment. Circulation, 105(7), 886–892. https://doi.org/10.1161/hc0702.103727

Tatum Lii, P. E., Talabreza, S., & Ross, J. S. (2018). Geriatric assessment: An office-based approach. American Family Physician.

Week 1 Discussion: 0 year old white male with angina lives on a farm 80 miles away from a healthcare cente

COLLAPSE

When a healthcare professional needs to influence a patient to change health-related behaviors, communication is essential. It can differentiate between a motivated patient and a disengaged patient, between successful prevention and chronic disease. What to say, how to do it, and above all, what does it change? Behavioral science shows how familiar to physicians; the patient-centered approach provides part of the answer.

Communication strategies can help healthcare professionals create conditions conducive to behavioral change within their consultations.

First, it provides a frame of reference; a group of behavioral science experts recently defined the notion of motivational communication. This style of communication is specially adapted to the medical context and includes:

Active listening.
The selection of clear and achievable objectives.
The response to resistance.
The evocation of the discourse of change.
The neutral presentation of information.

Second, it presents ways of being, including demonstrating respect, collaboration, and empathy.

Finally, certain attitudes can undermine the health assessment, such as judging or blaming the patient, being hostile or impatient towards him, or slipping into argumentation or conflictual.

Interview and Communication Techniques

This week’s scenario involves an 80-year-old white male with angina who lives on a farm 80 miles away from a healthcare center.

Late adulthood, including individuals aged 65 years and above. is the fastest-growing age division of the United States population (Owlia et al., 2019).

The standardized geriatric assessment is a medical examination allowing to take stock of the physical and/or psychic alterations and the functional incapacities of the subject. A specialized gerontological team carries out this evaluation in the presence or absence of the attending physician. The objective is to define care priorities and support for seniors according to the evolution of their state of health. The caregiver is an integral part of the process. The medical team thus questions him because he knows the patient he accompanies daily.

A potential health-related risk is our patient is an elderly man who lives far away from a hospital setting.

The geriatric assessment has several missions:

Observing and evaluating a deteriorating state of health in an older adult
Prevent certain risks (falls, addiction, etc.),
Avoid repeated hospitalizations that cause significant health costs, especially coronary heart disease.
Set up specific medical care to keep the patient at home.

How is a geriatric assessment carried out?

Our patient lives far away. He can benefit from many specialized services, hospitals, or care facilities for the elderly who offer geriatric assessments, depending on the patient’s medical condition, history, and environment.

The conclusions of the examination are then transmitted to the patient, his family, the care giver, and the attending physician who provides personalized advice. Other consultations can be scheduled depending on the patient’s condition; the objective is to set up appropriate comprehensive care to prevent worsening of the medical condition.

We can include other topics in our health assessment, such as polypharmacy, nutrition, vision, nutrition, and hearing. Our patient is 80 years old, and we can’t assume that he is cognitively impaired.

Risk Assessment Tool

Coronary heart disease is the most common cause of death in the United States. It is responsible for one out of every five deaths. Treatment of cardiovascular risk factors has resulted in a 50 percent reduction in deaths from CHD over the past 30 years (Anthoney et al., 2010).

The Framingham Global risk Assessment tool has been used considerably for elderly adults; it’s believed to be the “gold standard” for risk assessment for patients with coronary heart disease. It is a comprehensive test that assesses total cholesterol, diabetes, high-density lipoprotein, age, and smoking (Coke, 2016).

Five Targeted Questions to Ask the Patient

1- Pain Characteristics

Where is your pain? (location), does it go anywhere else? (radiation), when did it start? (onset), How long has it lasted? (duration). What makes the chest pain gets better or worst?

For some patients, the pain is felt more atypically and described as numbness, discomfort, or burning. Angina pain can vary in intensity on a scale of 1 to 10. It is usually located at the retrosternal level and can radiate to the neck, jaw, upper limbs, and back. Sometimes the pain can be felt in the epigastrium. It is essential to pay attention to symptoms such as dyspnea, weakness, fatigue, nausea, and belching, which can be anginal equivalents in the elderly, women, and diabetics.

2- Home environment

Who do you live with? How often do you have a health assessment, and how do you get to the hospital in case of an emergency.

3- What are some symptoms that you are having?

Do you have any of the following: weakness, shortness of breath, cold sweat, fatigue, nausea, dizziness, indigestion?

4- Do you have any of the following risk factors? Hypertension, prior history of angina, family history of heart disease?

5- Are you taking any medication for your angina? When was the last time you had an EKG? Do you smoke, drink, or use any illicit drugs?

References

Owlia, M., Dodson, J. A., King, J. B., Derington, C. G., Herrick, J. S., Sedlis, S. P., Crook, J., DuVall, S. L., LaFleur, J., Nelson, R., Patterson, O. V., Shah, R. U., & Bress, A. P. (2019). Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina. Journal of the American Heart Association, 8(15), 1–12. https://doi.org/10.1161/JAHA.119.012811

Anthony J. Viera|Stacey L. Sheridan. (2010, August 1). Global risk of coronary heart disease: Assessment and application. AAFP American Academy of Family Physicians. https://www.aafp.org/afp/2010/0801/p265.html

Coke, L. A. (2016). Cardiac Risk Assessment of the Older Cardiovascular Patient: The Framingham Global Risk Assessment Tools. Try This: Best Practices in Nursing Care to Older Adults, 1–2.

I really liked the way you presented your discussion post; it was very organized and thought out. However, as a PMHNP student, I was inclined to read through a few articles and I came across the following Risk assessment tools that would assess the psychological issues associated with one’s LGBTQIA status.

The Gender Minority Stress and Resilience Scale (GMRS) is used to measure the difficulties associated with identifying as a gender minority and protective factors for psychological well-being.The 58 items were adapted from other measures and compiled into the GMRS to measure nine different constructs, including Gender-related Discrimination, Gender-related Rejection, Gender-related Victimization, non-affirmation of Gender Identity, Internalized Transphobia, Negative Expectations for Future Events, and Nondisclosure (Shulman et al., 2017).

Strength of Transgender Identity Scale (STIS)This assesses how strongly an individual identifies as transgender and how important transitioning is to them. Although largely related to identifying transgender people, it contains items that may be relevant to understanding someone’s gender identity and how that might change in therapeutic interventions. The STIS has six questions and no factors were identified in the original validation study. Example items include “I identify as trans,” “It is important to me that people I am close to know I transitioned,” and “The fact that I transitioned is important to who I am.”

Transgender Adaptation and Integration Measure (TG AIM) measure the stresses associated with being transgender and the individual’s efforts to cope with stress. The TG AIM has 15 items, and three factors were identified in the initial validation study that is scored as subscales: Coping and Gender Reorientation Efforts, Psycho social Impact of Gender Status, and Gender-related Fears. A fourth factor, Gender Locus of Control, was also identified but was not recommended for use due to poor internal consistency. Example items of the three recommended factors include “I fear discrimination,” “I take/have taken hormones,” and “Being transgender causes me relationship problems.”

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.

Shulman, G. P., Holt, N. R., Hope, D. A., Mocarski, R., Eyer, J., & Woodruff, N. (2017). A review of contemporary assessment tools for use with transgender and gender nonconforming adults. Psychology of Sexual Orientation and Gender Diversity, 4(3), 304–313. https://doi.org/10.1037/sgd0000233Links to an external site.

Effective nursing health assessment interview techniques. (n.d.). Walden University. https://www.waldenu.edu/online-bachelors-programs/bachelor-of-science-in-nursing/resource/effective-nursing-health-assessment-interview-techniquesLinks to an external site.

NURS 6512 Discussion: Building a Health History