NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY

To prepare:

Struggling to meet your deadline?

Get your assignment on NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY done by certified MDs and PhDs in the USA. ORDER NOW!

Meet my deadline

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? NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY
• 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.

Introduction

This case study involves an 85-year-old Caucasian woman who lives alone and is experiencing declining health. To provide a comprehensive analysis, I have utilized the SOAP note format, which is presented below:

Subjective (S): JD is an 85-year-old white woman who came to the emergency department concerned about her deteriorating health, primarily due to multiple falls and pain in her left hip. The falls began approximately a year ago and have been happening more frequently and severely over the past three months. The most recent fall occurred today when she was getting up to use the bathroom, causing her to fall on her left side. She immediately called 911. She mentioned that the pain in her left hip worsens when she puts weight on it, and she’s unable to bear any weight on the left side. She hasn’t taken any pain medication and describes the pain as 10/10 when she engages in weight-bearing activities or attempts to move. She doesn’t use any assistive devices for mobility, eats one meal a day, and tries to have a Boost supplemental shake daily. Additionally, the patient experiences occasional urine incontinence and doesn’t have any relatives or friends available to assist her. She can still drive but avoids nighttime driving.

Her medical history includes osteoporosis, hypertension, dyslipidemia, anxiety, and depression. Her current medications include metoprolol tartrate 50 mg twice daily, atorvastatin 20 mg daily, sertraline 50 mg daily, a daily multivitamin, and vitamin D3 25 mcg daily.

Objective (O): JD is an elderly white woman who appears frail, undernourished, and anxious. She is alert and oriented. Her vital signs show a blood pressure of 143/94, pulse rate of 101, respiratory rate of 20, oxygen saturation of 97% on room air at rest, and a temperature of 97.8°F. She weighs 91 pounds and stands at a height of 5’1″, resulting in a BMI of 17.2. Notable bruising is observed on her left lower extremity (LLE), extending from the lateral aspect of the hip medially toward the groin and distally above the knee. X-rays confirm a left femoral neck fracture.

Assessment (A): The assessment includes:

1. Traumatic fracture of the left femoral neck
2. Falls
3. Malnourishment
4. Hypertension
5. Osteoporosis
6. Dyslipidemia
7. Anxiety
8. Depression

Plan (P): The plan consists of immediate hospital admission for surgery to address the traumatic left femoral neck fracture. Referral and transfer to orthopedics are arranged. The patient receives education on proper nutrition and maintaining a healthy weight, using teach-back techniques and providing literature. A discussion with the patient about her safety at home results in her plan to return home. After discharge, the patient will follow up with the orthopedic surgeon, primary care provider, and cardiologist. There’s also a discussion about the potential discharge to a skilled nursing facility, and the patient agrees with this plan. Medication adjustments involve the addition of hydrocodone-acetaminophen 5-325 every 4-6 hours as needed, with no medications discontinued.

Communication and Interview Techniques

Effective communication and interview techniques are crucial when dealing with various patient populations. In this case study, the patient is an 85-year-old woman. Studies have shown that the elderly often seek emergency care only for severe or life-threatening injuries. The patient does not have hearing or visual impairments, so no specific adjustments are necessary. However, the provider should position themselves close to the patient with minimal barriers between them. Maintaining eye contact, using open body language, appropriate non-verbal cues, and asking relevant follow-up questions are vital to building trust with the patient. Given that this interview occurs in the emergency department, it needs to be focused and efficient. Starting with open-ended questions to determine the patient’s primary concern and gradually delving into more personal topics, such as lifestyle and socioeconomic status, is a suitable approach. Questions should be asked one at a time, allowing the patient to respond fully before moving on. As the patient is in an emotional state, providing educational materials in the form of literature is essential to ensure she has information to refer to later. Keeping the patient informed at each stage of care is critical to alleviate anxiety and ensure safe outcomes.

Risk Assessment Instrument

Several risk assessment instruments are relevant in this case study. The primary one is a fall risk assessment tool, as falls have been a significant issue for the patient. The Johns Hopkins Fall Risk Assessment Tool is a widely used instrument, comprising seven questions related to age, fall history, elimination patterns, medication use, patient care equipment, mobility, and cognition. A total score between 6-13 indicates moderate fall risk, while scores greater than 13 indicate a high fall risk. In this case, the patient is at a high fall risk due to her age (85), falls within the past six months, incontinence, medication use (antihypertensive, opiate), and impaired mobility.

Another relevant risk assessment tool pertains to nutritional status. Malnourishment is a known risk factor for falls, and this tool can help address it. The Mini Nutritional Assessment Short-Form (MNA) is commonly used for the elderly and considers various factors like appetite loss, altered taste and smell, thirst loss, frailty, and depression. Given the patient’s below-recommended BMI and limited food intake, providing education on the importance of a healthy diet to prevent future falls and fractures is crucial.

Health Risk Interview Summary

– What is your past medical history?
– What is your living situation?
– Do you live alone? Do you have any relatives or friends who can assist you?
– What obstacles within your home make it difficult to complete daily activities? Do you use an assistive device for mobility?
– Walk me through a typical day.
– How many meals are you eating, and what do they consist of?
– What are your bowel and urinary habits? Do you wake up at night to use the bathroom?
– Can you shower or bathe yourself? Do you use any assistive devices, and do you feel safe during these activities?
– How do you manage your medications? Do you take them as prescribed, and how do you obtain them?
– How often do you fall in a week, month, or year?
– Is there a specific time of day or activity associated with your falls?

References

Adly, N. N., Abd-El-Gawad, W. M., & Abou-Hashem, R. M. (2019). Relationship between malnutrition and different fall risk assessment tools in a geriatric in-patient unit. Aging Clinical and Experimental Research, 32(7), 1279–1287. https://doi.org/10.1007/s40520-019-01309-0

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.

Hoek, A. E., Anker, S. C., van Beeck, E. F., Burdorf, A., Rood, P. P., & Haagsma, J. A. (2020). Patient discharge instructions in the emergency department and their effects on comprehension and recall of discharge instructions: A systematic review and meta-analysis. Annals of emergency medicine, 75(3), 435-444. https://doi.org/10.1016/j.annemergmed.2019.06.008Links to an external site.

Johns Hopkins Medicine. (n.d.). Fall risk assessment tool. Retrieved from https://www.hopkinsmedicine.org/institute_nursing/_docs/JHFRAT/JHFRAT%20Tools/JHFRAT_acute%20care%20original_6_22_17.pdfLinks to an external site.

Lutz, B. J., Hall, A. G., Vanhille, S. B., Jones, A. L., Schumacher, J. R., Hendry, P., … & Carden, D. L. (2018). A framework illustrating care-seeking among older adults in a hospital emergency department. The Gerontologist, 58(5), 942-952. https://doi.org/10.1093/geront/gnx102Links to an external site.

Reber, E., Gomes, F., Vasiloglou, M. F., Schuetz, P., & Stanga, Z. (2019). Nutritional risk screening and assessment. Journal of clinical medicine, 8(7), 1065. https://doi.org/10.3390/jcm8071065Links to an external site.

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

Additional Risk Factors

As you mentioned, this patient faces several risk factors. One additional concern for this patient is the risk of developing pressure injuries (PI). Assessments to determine this risk can be conducted using either the Waterlow or Braden Scales, both of which are highly effective in identifying pressure injury risks. It’s worth noting that a low body mass index (BMI) below 18.5 places a patient at a heightened risk for pressure injuries. With your patient having a BMI of 17, they are indeed at risk. It’s essential to consider factors such as frailty, including cognition and functional status. Frailty is a state that can follow a significant stressor, like a fall, and it increases the risk of the patient’s ability to maintain stability within their body. Frailty can lead to further adverse outcomes, including more falls, delirium, a need for long-term care due to disability, and even death. Given that the patient is currently bedbound with a broken hip, their functional status becomes a significant concern for preventing pressure injuries. Early intervention is crucial in preventing pressure injuries at the time of admission.

You also pointed out the patient’s poor nutritional status. Malnutrition can affect older adults when they are hospitalized due to acute illnesses and comorbidities. This patient will have periods of not being able to eat or drink (NPO) due to the need for surgery. Conducting a nutritional screening can prompt requests for a consultation with a dietitian. It’s important to note that even when nutritional assessments trigger best practice alerts for a nutritional consult upon admission, they may not always result in the consult actually being scheduled for the patient.

Another critical assessment to perform for the patient is a delirium assessment. Older individuals hospitalized for various reasons are particularly at risk for developing delirium. Delirium can manifest in different ways, such as hyperactive, hypoactive, or mixed features. One study used the Confusion Assessment Method (CAM) scoring and found that approximately 10% of acutely hospitalized patients with fractures developed delirium, leading to significantly longer hospital stays. To manage delirium, interventions like early mobility, proper hydration, adequate nutrition, pain management, sleep maintenance, and, if necessary, pharmacologic therapy can be considered. However, prevention is always preferred over treatment, and early screening and nonpharmacologic interventions, such as hydration and nutrition, can have effective results in elderly patients.

Dont wait until the last minute.

Provide your requirements and let our native nursing writers deliver your assignments ASAP.

Start My Order