NURS 6512 Building a Health History
Sample Answer for NURS 6512 Building a Health History Included After Question
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 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. JAMA, 325(17), 1765. https://doi.org/10.1001/jama.2021.1527
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 Health, 18(1). https://doi.org/10.1186/s12889-018-5653-9
A Sample Answer 2 For the Assignment: NURS 6512 Building a Health History
Title: NURS 6512 Building a Health History
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 genetics, 50(3), 401–413. https://doi.org/10.1038/s41588-018-0064-5
A Sample Answer 3 For the Assignment: NURS 6512 Building a Health History
Title: NURS 6512 Building a Health History
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.
A Sample Answer 4 For the Assignment: NURS 6512 Building a Health History
Title: NURS 6512 Building a Health History
Your post was thorough and responsive to the needs of the patient. The patient’s history of type 2 diabetes causes a decrease in insulin secretion that leads to less glucose in the cells, tissues, and organs for energy (McCance & Huether, 2019). With the genetic component of diabetes, this patient is at higher risk for complications associated with diabetes since he also stated a family history(Rosenthal & Burcham, 2019). Based on the medications the patient is taking, it is evident he is exhibiting comorbidities such as hypertension and dyslipidemia (Bernabe-Ortiz et al., 2022).
As patients age, medication cost can be a factor in medication compliance, so addressing the patient’s ability to afford medications (Obuobi et al., 2021). It is also important to address how the patient receives his medications as most pharmacies will deliver medications versus a personal pick-up (Obuobi et al., 2021). Medication cost that contributes to compliance is also a factor that you addressed in your interview (Mishra et al., 2018). Since the patient lives in a rural area, it would be beneficial to inquire if the patient is open to home health services to monitor signs and symptoms, as well as check the patient’s A1C to determine the control of his diabetes (Bhalodkar et al., 2020).
As you stated, this is a factor in the patient experiencing angina and hypertension. I agree with assessing his transportation access to a primary care provider to help maintain his healthcare as many elderly people have difficulty obtaining transportation, which is why establishing home health would be a good resource (Bhalodkar et al., 2020). A primary care provider is necessary to order this service. The patient’s disease processes are intertwined so lifestyle, diet, exercise, and smoking play a factor in his angina, T2DM, hypertension, and hyperlipidemia (Obuobi et al., 2021). Establishing trust through a thorough assessment builds a foundation of trust that leads to empowering the patient and family to own the healthcare management.
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.
Bernabe-Ortiz, A., Borjas-Cavero, D. B., Páucar-Alfaro, J. D., & Carrillo-Larco, R. M. (2022).
Multimorbidity Patterns among People with Type 2 Diabetes Mellitus: Findings from Lima, Peru. International Journal of Environmental Research and Public Health, 19(15). https://doi.org/10.3390/ijerph19159333
Bhalodkar, A., Sonmez, H., Lesser, M., Leung, T., Ziskovich, K., Inlall, D., Murray-Bachmann, R., Krymskaya, M., & Poretsky, L. (2020). the effects of a comprehensive multidisciplinary outpatient diabetes program on hospital readmission rates in patients with diabetes: a randomized controlled prospective study. Endocrine Practice, 26(11), 1331–1336. https://doi-org./10.4158/EP-2020-0261
McCance, K.L. & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). St. Louis, MO: Mosby/Elseier
Mishra, Vinaytosh, Samuel, Cherian &Sharma, S.K. (2018). Supply chain partnership assessment of a diabetes clinic. International Journal of Health Care Quality Assurance, 31(6), 646–658. https://doi-org./10.1108/IJHCQA-06-2017-0113
Obuobi, S., Chua, R. F. M., Besser, S. A., & Tabit, C. E. (2021). Social determinants of health and hospital readmissions: can the HOSPITAL risk score be improved by the inclusion of social factors? BMC Health Services Research, 21(1), 5. https://doi-org./10.1186/s12913-020-05989-7
A Sample Answer 5 For the Assignment: NURS 6512 Building a Health History
Title: NURS 6512 Building a Health History
Building rapport with the patient
As advanced practice registered nurses (APRNs), it is imperative to obtain a thorough health history from the patient interview process. The history is vital to guiding the physical examination and to interpreting physical exam findings ( Ball et al., 2019). One way to effectively build a health history during the interview process is to develop a rapport or relationship with the patient.
Establishing a positive patient relationship depends on effective communication built on courtesy, comfort, connection, and confirmation (Ball et al., 2019). Each patient is unique and must be treated as such. Communication and interview techniques for building a health history can differ with each patient based on age, learning abilities, and the patients’ reading level. The purpose of this discussion is to identify techniques in building a health history with an adolescent white male with no insurance seeking medical care for an STI.
Crucial factors of consideration
According to the World Health Organization (WHO), adolescence is the phase of life between childhood and adulthood, from ages 10 to 19. It is a unique stage of human development and an important time for laying the foundations of good health (2022). Even through the adolescent years, there are significant diseases/illnesses and injuries. During this phase, adolescents establish patterns of behaviour – for instance, related to diet, physical activity, substance use, and sexual activity – that can protect their health and the health of others around them, or put their health at risk now and in the future (WHO, 2022). During the adolescent phase, it is important to provide correct age-appropriate sexual activity information.
Assessment
The collection and analysis of information regarding an individual’s current and overall health is a health assessment and is provided by the patient subjectively (Ball et al., 2019). Considering this patient is coming to the appointment for concerns for an STI, it is imperative for the APRN to not be judgemental. This will allow the patient to feel comfortable sharing information such as signs and symptoms of the probable STI, number of partners, past history of an STI, and their gender identity.
The physical assessment is just as important as obtaining a health history. Physical exams should include inspection, auscultation, percussion, and palpation of the patient to verify the patient’s report objectively (Ball et al., 2019). As part of the physical assessment, the APRN may also conduct a male genitalia examination and obtain cultures of fluid to test for certain STIs such as, chlamydia, gonorrhea, and syphilis. Labs may also be ordered to check for those certain STIs.
At the end of the examination, targeted needs would be beneficial to address. For example, this patient does not have medical insurance. Since the patient is an adolescent, one would assume they are on their parent’s medical insurance as a dependent. Sometimes, adolescents are too afraid and uncomfortable to tell their parents and/or guardians any reproductive issues. Oftentimes, adolescents come into clinics secretly and say they do not have medical insurance so their parents/guardians do not find out about the visit once billed.
Asking questions such as why don’t you have insurance? Do your parents/guardians have medical insurance? Do they know about your visit to the clinic today? Can help identify any patterns or concerns without being assumptive. Providing support and comfort can help alleviate any hesitancy in answering the above questions. Finding and establishing important resources can help make sure the patient is getting the care they need outside of the clinic.
Specific targeted questions
Asking appropriate questions and avoiding stereotypes is essential to providing care that is tailored to the individual patient (Ball et al., 2015). With this particular patient, sexual information should be obtained in a non-judgemental manner. Targeted questions such as 1) What brings you to the clinic today? 2) How many partners do you currently have? 3) What are your current sexual practices (anal, oral, vaginal)? 4) What protection do you use to prevent STIs? 5) Have you had any STIs in the past? 6) What are your symptoms? And when did they start? Utilizing the screening tool PACES would also be beneficial for this patient. PACES stands for parents/peers, accidents/alcohol/drugs, cigarettes, emotional issues, and sexuality/school (Ball et al., 2019). PACES identifies these categories specifically for adolescents because oftentimes they are what is important to this age group.
Conclusion
A successful health assessment and interview process between an APRN and their patients requires a good rapport/relationship as the foundation. Identifying considerations and tailoring specific targeted questions to individual patients can be beneficial. Patient-centered care is an important contributor to a positive patient care experience (Dang et al., 2017). Actively engaging and listening to each patient is important. This will help the patient feel more comfortable expressing their concerns and needs.
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.
Dang, B. N., Westbrook, R. A., Njue, S. M., & Giordano, T. P. (2017). Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC medical education, 17(1), 1-10.
World Health Organization. (2022). Adolescent health. Retrieved from https://www.who.int/health-topics/adolescent-health#tab=tab_1
A Sample Answer 6 For the Assignment: NURS 6512 Building a Health History
Title: NURS 6512 Building a Health History
when dealing with people who have sexually transmitted diseases, it is imperative as you mentioned to not come off as judgmental. Something that healthcare providers forget, and I think people in general forget, is that tone is essential when it comes to communicating. I have read several books on negotiation and communication, and it never ceases to surprise me the things the negotiator is able to accomplish by implementing a few strategies.
One hostage negotiator has been able to convince dangerous people who have murdered people by the dozens, to release hostages and years later (Voss, 2016). The people who end up releasing the hostages tend to still be content with their decision years later (Voss, 2016). The author says he accomplishes hostage release mostly through tone and making the person feel understood (Voss, 2016). If we can get patients to say “that’s right” when we sum up their concerns and narratives about what is going on, we have reached a new level in the relationship (Voss, 2016).
At that point, they trust us more. Being submissive and having an interview approach style more like Oprah, will get a patient to feel like we are genuinely seeking to understand them and not just treat them (Voss, 2016). I think when patients think we are only there to treat them the relationship is more transactional than anything. When you think about transactional relationships, they are not relationships where you trust the person per say, in any deep way. You may trust the institution they work for more than the employee him or herself.
Whenever I am interviewing a patient, I always think, how would Oprah or Joe Rogan sound in this moment? Their tones are almost always curious, casual, and inviting. Unconsciously, their tones let a person know they are interested in what the person has to say and unbothered by it all at the same time. Eventually, the right tone dissipates discomfort (Voss, 2016). This is probably because in the beginning they’re just imagining how someone is going to react to their situation but once confronted with how it plays out, they realize their perception was off (Peterson, 2021). We really are all just taking our best guess as to how to best move around in the world (Peterson, 2018). Some psychologists call this a mental map (Peterson, 1999). Often times though, the map is inaccurate and in this case the patient would be pleasantly surprised.
References
Peterson, J. B. (2018). 12 Rules for Life: An antidote to chaos. Vintage Canada.
Peterson, J. (2021). Beyond order. Random House Canada.
Peterson, J. B. (1999). Maps of meaning. Taylor and Francis.
Voss, C. (2016). Never split the difference. Penguin.