NURS – 6512N Advanced Health Assessment & Diagnostic Reasoning -Week 1 Discussion Board Post : Building a Health History
Building a Health History
4-year-old biracial male living with his grandmother in a high-density public housing complex.
In assessing a 4-year-old child accompanied by his grandmother, most of the health information will come from the grandmother since the child is still too young to grasp most of the questions. I would ask the grandmother about the birth of the child and immunization history. I would also seek information on the family’s health history. The grandmother is more useful in providing information regarding the patient’s family history. I will also be interested in understanding the social situation that led to the boy staying with the grandmother and not the parents. Additionally, I would evaluate the lifestyle to know whether the grandmother has a support system. Finally, my assessment will examine the child’s cognitive, social/emotional, motor, language/communication skills, and education if he has started school.
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While the grandmother is the primary source of information, I will still engage the child to talk about his health. First, I will use one of the toys in the room appropriate for his age to gain his attention and interest. Secondly, I will guide the child to sit in a comfortable position to hear and see what I am doing (Ball et al., 2019). I will use simple terms to explain the procedures to him. I may have to repeat some explanations, talk slowly, or use demonstrations to enhance the child’s understanding because, at four years, a child is not very attentive and becomes easily distracted. While talking to the child, I will give him time to process information and ask questions.
According to Healthy People 2030, social determinants heavily impact people’s outcomes of health, wellbeing, and quality of life (Healthy People 2030, 2020). Thus, social determinants of health are crucial for understanding a patient’s risk and protective factors. According to the case description, the patient comes from low socioeconomic status. Staying in a high-density public apartment complex exposes the patient to poor health outcomes. Living in low-income neighborhoods compromises the child’s access to clean air, water, health facilities, healthy meals, transportation, and safety. These factors pose the risk of a child’s poor physical, mental, and emotional health. Moreover, the fact that the parents are not present also contributes to psychological issues. Given the responsibility of taking care of a small child at her age, the grandmother may also e experiencing strain, pressure, and stress, affecting her ability to provide proper care and security for the boy (Lange et al., 2019). Finally, biracial also expose the boy to the risk of discrimination, leading to psychosocial issues.
Using health assessment tools provides a deeper understanding of a patient’s risk factors and other issues impacting health outcome, wellbeing, and quality of life. In this scenario, I would use the Ages & Stages Questionnaires®: Social-Emotional, which examines emotional and social development. The grandmother will answer the assessment questions that take 10-15 minutes to complete. The assessment will reveal whether the patient is having challenges socially and emotionally, which he is highly vulnerable to given the socioeconomic background and absence of the parents. I would also use the Psychosocial Assessment Tool (PAT) to screen the caregiver, who is the grandmother. PAT investigates the psychosocial issues affecting the parent/guardian, compromising her ability to provide proper care (Verma & Mehdian, 2020).
Targeted Questions
- Do you have friends?
- Does your grandmother treat you well?
- Do you ever feel sad because you don’t have your parents around?
- Do you like playing with other children, are they mean to you?
- Do you feel pain in any part of your body?
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References
Ball, J., Dains, J., Flynn, J., Solomon, B., & Stewart, R. (2019). Seidel’s guide to physical examination (9th ed.). Elsevier.
Healthy People 2030. (2020). Social Determinants of Health. Retrieved from Healthy People 2030: https://health.gov/healthypeople/objectives-and-data/social-determinants-health#:~:text=Social%20determinants%20of%20health%20(SDOH)%20have%20a%20major%20impact%20on,Racism%2C%20discrimination%2C%20and%20violence
Lange, B. C., Callinan, L. S., & Smith, M. V. (2019). Adverse childhood experiences and their relation to parenting stress and parenting practices. Community mental health journal, 55(4), 651-662.
Verma, R., & Mehdian, Y. (2020). Screening for caregiver psychosocial risk in children with medical complexity: A cross-sectional study. Child Health Research, https://www.researchgate.net/publication/343774844_Screening_for_caregiver_psychosocial_risk_in_children_with_medical_complexity_A_cross-sectional_study.
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:
4-year-old biracial male living with his grandmother in a high-density public housing complex.
To prepare:
- 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 instrument 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.
- Utilize scholarly, peer reviewed sources.
- Utilize SafeAssign drafts for authenticity report before final submission.
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.
*Optional resources to refer to in order to complete discussion board assignment.
Lange, B. C., Callinan, L. S., & Smith, M. V. (2019). Adverse childhood experiences and their relation to parenting stress and parenting practices. Community mental health journal, 55(4), 651-662.
https://www.sciencedirect.com/science/article/pii/S0735675718304789?via=ihub
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