BUILDING A HEALTH HISTORY Discussion -4 year old African American male living in a rural community
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 – Case – 4 year old African American male living in a rural community
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The U.S. Nursing Shortage: A State-by-State Breakdown
The Detailed Health History and Physical Examination
When collecting a comprehensive health history and performing a physical examination, various aspects must be considered (Sullivan, 2019). The health history and physical (H&P) include the primary concern along with the current illness, previous medical background, family history, social history, review of body systems, physical assessment, laboratory results, a list of issues with evaluations and potential diagnoses, as well as the treatment plan (Sullivan, 2019).
Understanding a Child’s Health History
Discussing a 4-year-old African American boy residing in a rural area requires a unique approach (Ball et al., 2019). There is no one-size-fits-all method for conducting an H&P; instead, the patient’s situation should guide the conversation (Ball et al., 2019). Effective communication is essential, so healthcare professionals should use plain language and ensure that patients understand. In emergency situations, emergency care takes precedence over the H&P (Ball et al., 2019).
First Steps in Pediatric Assessment
When working with children, one of the initial considerations is whether a legal guardian is present (Ball et al., 2019). Never assume that the person accompanying the child has legal authority. Ask direct questions, such as their name, their relationship to the child, and whether they can consent to care (Ball et al., 2019). It’s also crucial to involve the child in the introductions, making eye contact and addressing them respectfully (Ball et al., 2019). The child may answer some questions, while the guardian can provide further information (Ball et al., 2019). For subjective experiences, it’s best to hear the child’s perspective, while the guardian can offer insights beyond a child’s understanding (McCance & Huether, 2019). Using open-ended questions like “What led you to seek care today?” allows patients or guardians to share their stories (Ball et al., 2019).
Comfort and Assessment in Pediatrics
Children may feel anxious, so they should be allowed to sit where they’re comfortable, perhaps on a parent’s lap (Ball et al., 2019). High emotions can be involved, so healthcare professionals should use respectful candor to establish trust (Ball et al., 2019). Additionally, it’s important to assess the risk of maltreatment in vulnerable populations like children (van der Put et al., 2017). Ancillary staff assessments, such as those by social workers, have proven effective in risk assessment (van der Put et al., 2017). Combining clinical and social assessments can prevent cases from going unnoticed. Healthcare providers should also assess the guardian for signs of caregiving stress (van der Put et al., 2017). Witnessing violence can impact child development, and direct questions about this can open discussions (Ball et al., 2019).
Understanding the Child’s Environment
Exploring a typical day in the child’s life can provide valuable information (Ball et al., 2019). For example, even if there are no pets in the child’s home, there might be pets in a babysitter’s home, triggering allergies (Ball et al., 2019). This exploration can reveal social determinants of health and potential risks based on the child’s environment (Ball et al., 2019). Geographical location can also provide insights; for instance, living in an area with a history of child asthma cases due to air quality may necessitate asthma evaluation (Ball et al., 2019).
Developmental Milestones and Family History
Assessing a child’s developmental milestones is crucial (Ball et al., 2019). For a 4-year-old, this may involve evaluating their performance in preschool and their history of achieving developmental milestones (Ball et al., 2019). In preschool-aged children, gross motor skills are particularly significant and can affect various aspects of development (Amemiya et al., 2018). Monitoring these skills can help detect developmental delays (Amemiya et al., 2018).
Family history plays a vital role in pediatrics, as genetic diseases can be inherited (Ball et al., 2019). The child’s African American background may influence the risk of certain diseases (McCance & Huether, 2019). Understanding cultural and religious practices is essential for tailoring care appropriately (Ball et al., 2019).
Medication Considerations
When prescribing medications, healthcare professionals must address two key factors: affordability and understanding (Rosenthal & Burchum, 2021). It’s important to ascertain whether the guardian can afford the medication and if they comprehend the dosing instructions (Rosenthal & Burchum, 2021). Noncompliance may have underlying causes, such as financial constraints or a lack of understanding, which should be addressed (Rosenthal & Burchum, 2021). Healthcare providers should educate guardians about children’s unique responses to medications and the importance of post-dose monitoring (Rosenthal & Burchum, 2021).
In conclusion, a comprehensive health history and physical examination is an extensive process that plays a crucial role in patient care (Sullivan, 2019). Proper documentation is key, as it serves as a foundation for the patient’s entire clinical journey (Sullivan, 2019). Healthcare providers aim to deliver high-quality care, and it all starts with the initial H&P (Sullivan, 2019).
References
Amemiya, Y., Suzuki, S., & Satoh, M. (2018). A Support System for Gross Motor Assessment of Preschool Children. IECON 2018 – 44th Annual Conference of the IEEE Industrial Electronics Society, 4251–4256. https://doi.org/10.1109/IECON.2018.8591574
Ball, J.W., Dains, J.E., Flynn, J.A., Soloman, B.S., & Stewart, R.W. (2019). Seidel’s guide to physical examination: An interprofessional approach, (9th ed.). Elsevier.
McCance, K.L. & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children, (8th ed.). Elsevier BUILDING A HEALTH HISTORY Discussion -4 year old African American male living in a rural community.
Rosenthal, L.D. & Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants, (2nd ed.). Elsevier.
Sullivan, D.D. (2019). Guide to clinical documentation, (3rd ed.). F.A. Davis.
van der put, C.E., Assink, M., & Boekhout van Solinge, N.F. (2017). Predicting child maltreatment: A meta-analysis of the predictive
validity of risk assessment instruments. Child Abuse and Neglect, 73, 71-88. https://doi.org/10.1016/j.chiabu.2017.09.016
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
BUILDING A HEALTH HISTORY Discussion -4 year old African American male living in a rural community responses
You bring up a valid point about the affordability and understanding of medications prescribed. Obtaining and assessing the patient is indeed a crucial step in diagnosing a patient. However, as you mentioned, a diagnosis is only as good as the treatment provided if it is executed and adhered to. About three in ten adults report not taking their medicines as prescribed at some point in the past year because of the cost. This includes about one in six (16%) who report they have not filled a prescription, about one in five (22%) who took an over-the counter drug instead, and 13% who say they have cut pills in half or skipped a dose (Kaiser Family Foundation, 2022). As a practitioner, it is not only important to educate the patient/family, but also to discuss the feasibility in obtaining such prescriptions. In doing so, the practitioner can address the issue of cost and find alternate means to access the necessary medications. “Noncompliance” happens more often than we think because patients do not understand the need for the medicine, the nature of side effects or the time it takes to see results (American Medical Association, 2023). Communication is of utmost importance in order to properly diagnose and provide effective treatment.
References
American Medical Association. (2023, February 22). 8 reasons patients don’t take their medications. https://www.ama-assn.org/delivering-care/patient-support-advocacy/8-reasons-patients-dont-take-their-medications BUILDING A HEALTH HISTORY Discussion -4 year old African American male living in a rural community
Kaiser Family Foundation. (2022, October 20). Public Opinion on Prescription Drugs and Their Prices. https://www.kff.org/health-costs/poll-finding/public-opinion-on-prescription-drugs-and-their-prices/
response 2
I enjoyed reading your post. It was well-written and informative. I completely agree with you about there “not being a one size fits all technique.” Being able to relate and communicate with our patients can allow us to establish trust that fosters a good clinician-patient relationship. With minimal prompting, the patient can carry the conversation and provide much of the needed information necessary to complete a good H & P (Ball et al., 2019). When working with the pediatric population, conducting a good assessment of basic needs being met, psychosocial risks, and behavioral risks can help providers to tailor their care plan to address these issues. Pediatric patients that experience childhood stress, trauma, or neglect are more likely to have mental and physical health issues later in life (Oh et al., 2018). I love that you mentioned meeting childhood developmental milestones as a screening tool to be utilized for your assigned case scenario. Assessing if a child is meeting their developmental milestones can help clinicians to assess for delays or disabilities and intervene accordingly (Zubler et al., 2022). It is important to conduct a thorough health assessment and ensure accurate documentation in the patient’s chart. This will establish a health baseline that other clinicians can refer to and identify changes in the patient’s health (Ball et al., 2019). Great Post!
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.
Oh, D., Jerman, P., Silvério Marques, S., Koita, K., Purewal Boparai, S., Burke Harris, N., & Bucci, M. (2018). Systematic review of pediatric health outcomes associated with childhood adversity. BMC Pediatrics, 18(1). https://doi.org/10.1186/s12887-018-1037-7Links to an external site.
Zubler, J. M., Wiggins, L. D., Macias, M. M., Whitaker, T. M., Shaw, J. S., Squires, J. K., Pajek, J. A., Wolf, R. B., Slaughter, K. S., Broughton, A. S., Gerndt, K. L., Mlodoch, B. J., & Lipkin, P. H. (2022). Evidence-informed milestones for developmental surveillance tools. Pediatrics. https://doi.org/10.1542/peds.2021-052138 BUILDING A HEALTH HISTORY Discussion -4 year old African American male living in a rural community
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