NURS 6512 Building a Health History

NURS 6512 Building a Health History

Sample Answer for NURS 6512 Building a Health History 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: NURS 6512 Building a Health History

Title: NURS 6512 Building a Health History

 

 

 

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

NURS 6512 Building a Health History
NURS 6512 Building a Health History

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.

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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. JAMA325(17), 1765. https://doi.org/10.1001/jama.2021.1527

Links 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 Health18(1). https://doi.org/10.1186/s12889-018-5653-9

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 genetics50(3), 401–413. https://doi.org/10.1038/s41588-018-0064-5

Thanks for your interesting and thorough response.  The patient has a number of poor health choices that are reinforcing his angina.  Part of the assessment could be to determine if the patient understands that his nicotine use is contributing to his angina and whether the patient is motivated to quit.  Sadly the patient may value smoking more than the quality of his health and may be determined to make no changes.  Contrarily we may discover the patient feels helpless in his ability to quit tobacco, but strongly desires to, and we may be able to provide options for cessation.

Kaufman et al. (2020), offers a useful article on using interview questions to measure a patient’s perceived risk of smoking.  In this case the patient has a worsening cardiac condition that is causing pain and contributing to a low quality of life.  It would be useful to understand how the patient perceives smoking in relation to their poor health and if that could be a motivator for change.  Below are examples of general questions that could be used in a provider health assessment to determine the patient’s perception of their own risk.

“If you continue smoking the same number of cigarettes every day, how likely do you think it is that you will…,”

“If you stay quit, how likely do you think you will…,”

“If you never start smoking, how likely do you think you will…”

This could then give opportunity for health teaching and referral to/prescribing of cessation options.  For example, nicotine patches or cognitive behavior therapy for smoking cessation.  Importance of using specific language, for example, harm versus cancer versus lung cancer is emphasized by the authors.  People are more likely to rate their risks higher if language is more specific and will provide more motivation to change behaviors.  Additionally there may be a large difference in how people perceive the risk of smoking in general (to the general population) and to themselves.  The authors state a general trend of overestimating risk to the general population and underestimating their own risk.  What also can be useful to assess the patient’s perception of their risk is to pull in questions from the affective domain (involving their values), for example using the question “how worried are you that you will ….” based on a scenario where the patient does not quit smoking.  The article is a useful one to download for future use.  If we ever have an assignment where we have to design a comprehensive interview the suggestions the authors make are quite adaptable to a wide range of health topics.

Olenik and Mospan (2017) provides a summary of various tools that may help the interviewer determine how motivated a patient will be to quit smoking.  For example, the Transtheoretical Model for Readiness to Change would suggest that when a patient is not ready to quit smoking questions like stated previously can be used to ascertain if gaps in knowledge exist (precontemplation stage).  We can then provide accurate information so the patient can make an informed decision.  Whereas if the patient is motivated to quit (preparation stage) the practitioner may help the patient actively order cessation measures.  In this case the patient’s experience of angina may be sufficient motivation to want to quit.  The article also offers a summary on the pharmacological options available.  A useful tool for those interested in health promotion with patients who smoke and to look at individual options more closely.  For example the safety and efficacy of bupropion as a smoking cessation tool.

 

References

Kaufman, A., Twesten, J., Suls, J., McCaul, K.,  Ostroff, J., Ferrer. R., Brewer, N., Cameron, L.,  Halpern-Felsher, B., Hay, J., Park, E., Peters, E., Strong, D., Waters, E., Weinstein, N., Windschitl, P., Klein, W. (2020).  Measuring Cigarette Smoking Risk Perceptions.  Nicotine & Tobacco Research, 22(11), 1937-1945.

Olenik, A. & Mospan, C.  (2017).  Smoking cessation:  Identifying readiness to quit and designing a plan.  American Academy of Physician Assistants, 30(7), 13-19.