Shadow Health Assignments
NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY
Case B – An 85-year-old white female lives alone with no family and her health is declining.
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Case C – An adolescent white male without health insurance is seeking medical care for a sexually transmitted infection (STI).
Case E – An adolescent Hispanic/Latino boy lives in a middle-class suburb.
Case G – A 4-year-old African American male lives in a rural community.
For this discussion, you’ll take on the role of a clinician building a health history for one of the assigned patients.
Preparing for the Discussion:
Think about the communication and interview techniques you would use for each patient’s health history.
Consider how you’d ask questions based on the patient’s social determinants of health.
Decide which risk assessment tools would be suitable for each patient, and formulate questions to assess their health risks.
Identify potential health risks based on age, gender, ethnicity, and environment.
Choose a risk assessment tool from the resources provided or another you’re familiar with.
Develop at least five targeted questions for each patient to assess their health risks and start building their health history.
By Day 3 of Week 1:
Share a summary of the interview, explain the communication techniques you’d use, and justify your choices. Identify the risk assessment tool you chose and explain why it fits the patient. Present at least five specific questions you’d ask the patient to assess their health risks.
Introduction
The case I’m analyzing is about an 85-year-old white woman living alone with declining health. Here’s a SOAP note style summary of the case:
Subjective (S): The patient, JD, is an 85-year-old white woman who came to the ER due to declining health, multiple falls, and left hip pain. Falls have become more frequent and severe over the last year. The most recent fall happened when she was getting up for the bathroom, and she fell onto her left side. The pain in her left hip increases with weight-bearing activities. She can’t put weight on her left side and rates the pain as 10/10. She doesn’t use assistive devices, eats one meal a day, and has intermittent urine incontinence. She doesn’t have anyone to help her.
Objective (O): JD appears frail, malnourished, and anxious. Vital signs are within normal range, but her weight, height, and BMI are low. There’s bruising on her left leg, and X-rays show a left femoral neck fracture.
Assessment (A): Traumatic left femoral neck fracture, falls, malnourishment, hypertension, osteoporosis, dyslipidemia, anxiety, and depression.
Plan (P): JD will have surgery for the femoral neck fracture. She’ll be referred to orthopedics and educated on nutrition. She plans to return home safely and follow up with various specialists. Discharge plans include a skilled nursing facility. New medication includes hydrocodone-acetaminophen 5-325 as needed.
References: Information from Ball et al. and other sources.
NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY
NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY
- Case B 85 year old white female living alone with no family in declining health
- Case C Adolescent white male without health insurance seeking medical care for STI
- Case E Adolescent Hispanic/Latino boy living in a middle-class suburb
- Case G 4 year old African American male living in a rural community
For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient (above) assigned by your Instructor.
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? 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
The case study analysis assigned to me involves an 85-year-old white female living alone with no family who is in declining health. In expanding upon the case study, I utilized the SOAP note format, which is presented below:
Subjective (S): JD is an 85-year-old white woman who presents to the emergency department with concerns about declining health due to multiple falls and pain in the left hip. The falls began about a year ago and have increased in frequency and severity in the past three months. The most recent fall was today when the patient fell while getting up to use the bathroom, and she fell to the floor and landed on her left side. She immediately called 911. She states that pain in the left hip increases with weight-bearing activities, and she has been unable to put weight on the left side. She has not taken anything for the pain. She states that pain is 10/10 with any weight-bearing or ROM activities. She does not use any assistive devices for mobility. She eats one meal daily and tries to have a Boost supplemental shake daily. Patient has intermittent urine incontinence. She does not have relatives or friends available to assist her. She still drives, though she avoids driving at night.
ORDER A CUSTOM-WRITTEN ESSAY OR SHADOW HEALTH HELP
She has a history of osteoporosis, hypertension, dyslipidemia, anxiety, and depression. Her medications include: metoprolol tartrate 50 mg twice daily, atorvastatin 20 mg daily, sertraline 50 mg daily, multivitamin daily, and vitamin D3 25 mcg daily NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY.
Objective (O): JD is an older white woman who appears frail, malnourished, and anxious. Alert and oriented x 3. VS: 143/94, P 101, RR 20, 97% on room air at rest, and T 97.8F. Weight 91 pounds and height 5’1”. BMI is 17.2. Significant bruising was noted in the LLE from the lateral aspect of the hip that extends medially towards the groin and distally above the knee. X-rays demonstrate a left femoral neck fracture.
Assessment (A): 1.) Traumatic fracture of the left femoral neck 2.) falls 3.) malnourishment 4.) hypertension 5.) osteoporosis 6.) dyslipidemia 7.) anxiety 8.) depression.
Plan (P): Patient is being admitted to the hospital for immediate surgery for a traumatic left femoral neck fracture. Referral and transfer to orthopedics are planned. Patient was provided education on proper nutritional requirements and how to maintain a healthy weight via teach-back and literature. The provider had a conversation with the patient regarding the safety of living within her home, and the patient plans to return home accordingly. Patient is to follow up with the orthopedic surgeon, primary care provider, and cardiologist upon discharge. A discussion for plans to discharge from the hospital to a skilled nursing facility was had, and the patient agreed with this plan. Medication additions include: hydrocodone-acetaminophen 5-325 every 4-6 hours as needed. No medications were discontinued NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY.
Communication and Interview Techniques
Providers must efficiently use several communication and interview techniques with various populations. In this case study, the patient is an elderly 85-year-old woman. One study provides evidence that the elderly population does not tend to seek out emergency department care unless severe or life-threatening injuries occur (Lutz et al., 2018). She has no hearing or visual concerns; therefore, the provider does not need to make adjustments. The provider should position themselves near the patient with as few obstacles in between as possible (Ball et al., 2019). Maintaining eye contact, having an open posture, using appropriate non-verbal cues, and utilizing appropriate follow-up questions are necessary to gain the patient’s trust (Ball et al., 2019). Since the interview is occurring in the emergency department, the interview must be focused and timely. The provider should begin with open-ended questions to ascertain the patient’s chief concern and follow up with appropriate questions to gain the patient’s trust (Ball et al., 2019). Once rapport is developed and the patient is more at ease, the provider can ask more personal questions, such as about lifestyle and socioeconomic status (Ball et al., 2019). Questions should occur one at a time and in a manner that allows for the patient to respond fully before proceeding. Though the patient’s care will be transferred to the orthopedic surgeon, education should be provided to the patient. Since the patient is in a heightened emotional state, it is necessary to provide educational materials in the form of literature for the patient to reference later (Hoek et al., 2020). Keeping the patient informed at every step of care is imperative to ease the patient’s anxiety and ensure safe outcomes.
Risk Assessment Instrument
Several risk assessment instruments would be beneficial in this case study. A fall risk assessment tool is the most common and pertinent tool for the patient in this case study. A widely used tool is the Johns Hopkins Fall Risk Assessment Tool, which consists of 7 questions about age, fall history, elimination, bowel and urine, medications, patient care equipment, mobility, and cognition (Johns Hopkins Medicine, n.d.). Scores between 6-13 are a moderate fall risk, and greater than 13 points are a high fall risk (Johns Hopkins Medicine, n.d.). Patient in this case study is a high-fall risk as demonstrated by her age (85), fall in the past six months, incontinence, medications (antihypertensive, opiate), and impaired mobility NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY.
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