NURS 6512 Discussion: Building a Health History

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Week 1 Main Post
              The case study I selected was of the 76-year-old Black male with disabilities living in an urban setting.  Social determinants of health that impacted my patient’s health were his gender, age, ethnicity, and living in an urban environment.  According to Kanchi et al., (2018), black men age 45 and older were at a higher risk of fatal coronary heart disease.  Some of these risk factors are obesity, hypertension, diabetes, chronic kidney disease, enlarged prostate, or congested heart disease.  “African American men have the highest incidence of prostate cancer and the highest mortality rates compared to other population groups in the United States” (Sandiford & D’Errico, 2016, p 86).

Social determinants of health can influence my interview and communication techniques. Since the patient is an older person, I would use the Patient-Centered Questions, speak clearly and faced patient.  Keeping in mind of his disability, allow for patient to answer questions, he might need more time.  Make sure the room is set up appropriately, if patient need to have furniture moved to accommodate a wheelchair.  I would be courteous, seek a connection, don’t use jargon, and do a complete history, while delivering culturally competent care.

According to Cheng et al (2019) non-Hispanic black participants had an A1C that was elevated, which meant that study group had a prevalence of undiagnosed diabetes.  Risk assessment tools I would use is the problem-oriented medical record with using SOAP notes.

Five targeted questions I would ask:

  1. How many times do you urinate, especially during the night?  2.  Describe times when you had any chest pain or tightness?  3.  Describe any ankle/leg swelling?  4.  Do you have shortness of breathe with activity or when lying down?  5.  Tell me about any blurred vision or frequent urination.

References

Kanchi, R., Perlman, S., Chernov, C., Wu, W., Tabaei, B.P., Trinh-Shevrin, C., Islam, N., Seixas, A., Rodriguez-Lopez, J., Thorpe, L.E. (2018). Gender and race disparities                in cardiovascular disease risk factors among New York City adults: New York City Health and Nutrition Examination Survey (NYC HANES) 2013–2014.                              Journey  of Urban Health, 95(7), 801–812. https://doi.org/10.1007/s11524-018-0287-x

Sandiford, L., D’Errico, E. (2016). Facilitating shared decision making about prostate cancer screening among African American men. Oncology Nursing Forum, 43(1),                 86-92.

Cheng, Y., Kanaya, A.M., Araneta, M.R., Savdah, S.H., Kahn, H.S., Gregg, E.W., Fujimoto, W.Y., Imperatore, G. (2019). Prevalence of diabetes by race and ethnicity in                   the United States, 2011-2016. Journal of the American Medical Association, 322(24), 2389-2398.  https://doi:10.1001/jama.2019.19365

Discussion: Building a Health History

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.

Photo Credit: Sam Edwards / Caiaimage / Getty Images

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 “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

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.

 

I enjoyed your post, you did a great job with pointing out some risk factors for your patient. As you pointed out, “African-American men have higher incidence of prostate cancer and the highest mortality rates compared to any other population in the United States” (Sandiford & D’Errico, 2016). Another scary statistic is that research has shown that African American men have experienced higher rates of serious complications of type 2 diabetes, due to poor disease management” (Sherman, Hawkins, & Bonner, 2017). With your patient being disabled and elderly his disease management could possibly be more taxing. I feel you did well address issues he may have, he may be hard of hearing, being in a wheel chair you may need to move some furniture around in the treatment room, allow time for the patient to answer. As you stated a SOAP note would be appropriate to use. The Functional Assessment would also be a good tool to use as we would learn about this patient’s daily activities, instrumental activities as well (Ball et al, 2019). Questions I would use for this patient, Do you live alone? Do you do your shopping, or does someone help you? Are you taking your medication as directed? Do you have issues getting around the city in your wheelchair? How do you commute, do you use public transportation, do you drive yourself, do you have someone who helps with transportation?

Again, good post Jewel, you have a great list of questions for our patient. 

 

Reference

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.

Sandiford, L., D’Errico, E. (2016). Facilitating shared decision making about prostate cancer       screening among African American men. Oncology Nursing Forum, 43(1),  86-92.

Sherman, L. D., Hawkins, J. M., & Bonner, T. (2017). An Analysis of the Recruitment and          Participation of African American Men in Type 2 Diabetes Self-Management Research:           A Review of the Published Literature. Social Work in Public Health, 32(1), 38–48.           https://doi-org.ezp.waldenulibrary.org/10.1080/19371918.2016.1188742

 

I enjoy reading your post, it was very informative.

Indeed, chronic communicable diseases such as obesity, diabetes, cancers, cardiovascular diseases, and hypertension are more prevalent in African American males when compared to other ethnic groups, such as the Hispanic population. It is of interest to note that although African American men have the highest incidences of prostate cancer and highest mortality rates compared to other population groups in America. According to the CDC, 2017 African Americans are living longer and the death rate in the African American group has declined by 25% over 17 years, primarily for those aged 65 years and older.

Additionally, the elderly are vulnerable to the risk factors contributing to non-communicable diseases, whether from a sedentary lifestyle, unhealthy diets, harmful use of alcohol, and exposure to tobacco smoke (WHO, 2018). Being disabled may also negatively impact the patient’s effort to obtain healthcare.

Interview questions may also include

  1. Do you live alone?
  2. Can you tell me about your support system at home in terms of getting help with meal preparation and obtaining prescribed medications?
  3.  Do you take your medications as prescribed?

As primary care providers, we must connect patients with community resources that can help people remember to take their medicine as prescribed, get prescription refills on time, and get to follow-up visits (CDC, 2017).

References

 

CDC (2017). African American Health: Creating equal opportunities for health. Retrieved from

https://www.cdc.gov/vitalsigns/aahealth/index.html

WHO (2018). Noncommunicable diseases. Retrieved from https://www.who.int/news-room/fact-  

          sheets/detail/noncommunicable-diseases