Posted: December 20th, 2021

NURS 6512: Advanced Health Assessment and Diagnostic Reasoning – week 1 discussion Case Study

week 1 discussion

Case Study

14-year-old biracial male living with his grandmother in a high-density public housing complex.

The first meeting with a client sets the tone for a successful, trustful, and confidential relationship between the provider and the patient. The tone of interactions, flexibility, and composure all enhance the ability of the clinician to conduct a thorough interview. It is paramount for the provider to make every effort to view things from the patient’s perspective to prevent misinterpretations and misperceptions (Ball, Dains, Flynn, Solomon & Stewart, 2019). The institute of medicine (IOM) (as cited in Ball et al. 2019), opines that a meaningful partnership is centered on patient-centered care. IOM defined patient-centered care as “respecting and responding to patient’s wants, needs, and preferences so that they can make choices in their care that best fit their circumstance” (pg.2). in other words, communication, interview questions, and general health assessment should be patient-centered.

Communication and interview techniques.

The client in the case study is a 14 years old male living with the grandmother in a public housing complex. It is relevant for the assessor to communicate with the type of language the teenager can understand. I would utilize a patient-center communication technique and avoid medical jargon (Zelazny, Chang, Burke, Hawk, & Miller, 2019). I will provide a pre-visit questionnaire that would allow the teenager to express concern and then transit to verbal communication. First, I would provide privacy, followed by an introduction that would make the teenager comfortable. I would employ the open-ended approach and provides a sense of alliance to his responses (Ball et al. 2019). I would also provide information about confidentiality to re-assure him of the safety of the information he provided (Kadivar, Thompson, Wegman, Chisholm, Khan, Eddleton, Shenkman, 2014).

Target questions for building a health history based on the patient’s social determinants of health?

I would start with open-ended questions and then move to more targeted questions

Tell me about yourself. He would probably mention why he lives with his grandmother and ask questions related to family health.
Tell me more about your friends, and what do you do for fun?
How is school going/ how is school life working for you?
Do you and your friends ever use drugs or alcohol
Do you have a girlfriend? Tell me about your relationship? Are you sexually active?
What do you know about the sexually transmitted disease?
Health Risk Assessment Instrument

I would utilize HEEADSSS screening Tools for adolescents. HEEADSSS is an acronym for relevant factors related to adolescent health.

H – Home environment. This is where I will be asking questions relating to his home environment, where are his parents? Why is he living with a grandmother? And other family members who live with him

E-Education, employment: I will ask about the school and assess his area of interest. Is he bullied in school because he is biracial? How is he doing in academics?

E – Eating: I will explore his eating habits.

A – Activities: I will ask my clients about his daily activities, such as sport and what he likes to do for fun with friends and explore his extracurricular activities.

D – Drugs: I will ask if he has ever used the drug.

S – Sexuality. I will ask questions about dating, relationship, and sexuality

S – Suicide/depression. I will ask questions about depression, does he feel like hurting himself and explore his personality.

S – Safety from Injury. I will use the opportunity to ask if he has been abused or assaulted.

(Swapna & Kalyan, 2016).

Targeted questions to assess health risk

Tell me more about yourself and your family?
How is school going? Tell me more about what you like best or least about your school?
How would you describe your eating habits? Does your weight or body image cause you any stress?
Tell me more about your friends, what do you do for fun?
Have your friends in the neighborhood ever use drugs, smoke, or drink alcohol? If yes, have you ever join them to use them? Watch body language.
Tell me about your girlfriend? How would you describe your feelings towards the opposite sex?
Do you ever entertain thoughts of hurting yourself or others, do you feel sad and wish you don’t exist?
Have you been a victim of any abuse?
Potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.

Adolescence could be the most challenging phase in human development due to the emotional and physical changes. It is the years when Adolescence involves health risk behaviors such as drugs or alcohol use, risky sexual practices, and mental health concerns. The health providers can Help in addressing some of this dangerous behavior as some adolescence prefers to confide their health issues to their provider (Kadivar et al.2014). Another risk factor that should be taken into consideration is the environment. The adolescent, in this case, lives with his grandmother. We may have to consider the family background and the physical environment as well.

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.

Kadivar, H., Thompson, L., Wegman, M., Chisholm, T., Khan, M., Eddleton, K., … Shenkman, E. (2014).

Adolescent Views on Comprehensive Health Risk Assessment and Counseling: Assessing Gender

Differences. Journal of Adolescent Health, 55(1), 24–32. Retrieved from https://doi-

org.ezp.waldenulibrary.org/10.1016/j.jadohealth.2013.12.002

Swapna & Kalyan. (2016). Psychosocial Risk Status of Rural Adolescent Girls Using ‘Heeadsss’

Approach. Journal of Evidence-Based Medicine and Healthcare, (6), 189. https://doi-

org.ezp.waldenulibrary.org/10.18410/jebmh/2016/44

Zelazny, S., Chang, J., Burke, J., Hawk, M. & Miller, E. (2019). Adolescent and young adult

women’s recommendations for establishing comfort within family planning providers’ communication about and assessment for intimate partner violence. Journal of Communication in Healthcare, 2019. DOI:10.1080/17538068.2018.1560073

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